Objective Long non-coding RNA plasmacytoma variant 1 (Lnc-PVT1) is implied with neuron apoptosis, inflammatory cytokines recruitment, endothelial cell proliferation, and angiogenesis; the latter are closely implicated in acute ischemic stroke (AIS) pathology. However, clinical significance of Lnc-PVT1 in AIS management remains unexplored. Thus, this study aimed to investigate this topic. Methods In total, 110 patients AIS and 110 controls were enrolled. Peripheral blood mononuclear cells (PBMCs) and serum were extracted from AIS patients and controls. Then, RT-qPCR was performed to determine the PBMC Lnc-PVT1 expression in AIS patients and controls. Besides, we used ELISA to evaluate serum interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and IL-17A in AIS patients. Additionally, in terms of recurrence-free survival (RFS) analysis, the Lnc-PVT1 expression was classified from quantile 1 to quantile 4 regarding the Lnc-PVT1 expression in AIS patients. Results AIS patients had higher Lnc-PVT1 expression compared with that in controls (P < 0.001) with a good supplementary diagnostic value for AIS (area under the curve (AUC) = 0.916 (95%CI 0.881-0.951). Furthermore, Lnc-PVT1 expression was positively linked with NIHSS score (r = 0.380, P < 0.001), IFN-γ (r = 0.217, P = 0.023), TNF-α (r = 0.311, P = 0.001), IL-6 (r = 0.235, P = 0.014), and IL-17A (r = 0.253, P = 0.008), separately. RFS of AIS patients with Lnc-PVT1 quantile 1-2 was higher than that of patients with Lnc-PVT1 quantile 3-4 somehow (P = 0.050). Conclusion Lnc-PVT1 not only correlates with AIS risk, inflammation, and disease severity, but also reveals a dependable value for AIS prognostication, which still needs further studies for validation.