Aim To explore the risk factors of early neurological deterioration (END) after intravenous thrombolysis and the distribution of cerebral artery stenosis on anterior-posterior circulation. Methods 230 acute ischemic stroke (AIS) patients treated with intravenous alteplase were retrospectively analyzed. The patients were divided into END group and non-END group, which were assessed by National Institute of Health Stroke Scale (NIHSS) with criteria of whether neurological deterioration were≥4 points from baseline or leading to death at 24 hours after therapy. Risk factors of END were analyzed using multivariate Logistic regression model. And the distributions of clinically relevant arteriostenosis were studied on anterior-posterior circulation systems. Results Multivariate Logistic regression analysis showed that END was associated with age, baseline NIHSS score and moderate-severe stenosis of clinically relevant artery. The incidence of intracranial and extracranial artery stenosis in END group was significantly increased than non-END group on anterior circulation AIS (P＜0.05), but no significant distribution difference of cerebral artery stenosis was observed between END group and non-END group on posterior circulation systems AIS. Conclusions Age, baseline NIHSS score, moderate-severe stenosis of relevant artery are risk factors of END in AIS patients treated after intravenous thrombolysis with alteplase. Intracranial or extracranial artery stenosis could help to predict END in AIS patients on anterior circulation system.