Edaravone dexborneol (EdaBorneol) improves outcomes in anterior circulation acute ischemic stroke (AIS); however, its efficacy in reducing hemorrhagic transformation (HT) and functional outcomes following endovascular thrombectomy (EVT) in posterior circulation AIS, which has a high disability rate and risk of HT after EVT, remains unclear. Therefore, this study aimed to investigate the clinical efficacy and safety of pre-EVT EdaBorneol in patients with posterior circulation AIS. This single-center, retrospective, case-control study included 101 patients with posterior circulation AIS who underwent EVT at Beijing Shijingshan Hospital between January 2019 and February 2025. Patients were divided into EdaBorneol (n = 53) and control groups (n = 48). Logistic regression analyses were performed to evaluate the impact of EdaBorneol on HT and 90-day modified Rankin Scale scores ≤ 3. Subgroup analyses were conducted among patients who received bridging therapy and achieved successful recanalization. The EdaBorneol group exhibited a significantly lower 24 hours HT rate compared to the control group (odds ratio = 0.12, P = .003). A higher proportion of patients in the EdaBorneol group achieved good functional recovery compared to the control group (modified Rankin Scale ≤ 3; P = .001), with enhanced efficacy observed in reperfused patients (odds ratio = 0.03, P = .002). EdaBorneol can protect vascular endothelial integrity and reduce reperfusion injury. This study provides evidence-based support for the use of EdaBorneol in posterior circulation stroke management.