Previous research on racial disparities in mechanical thrombectomy (MT) treatment of acute major vessel occlusion stroke lacked individual patient data, which could have influenced treatment decisions. From 2016 to 2020, researchers looked at patient-level data in a large US healthcare system for racial discrepancies in MT utilization and eligibility. A retrospective research was conducted on 34,596 patients admitted to 43 hospitals between January 2016 and September 2020. Patient age, gender, race, median income, and population density by zip code, presenting hospital stroke certification, baseline ambulation, and the National Institutes of Health stroke scale were all included in the research. There were 26,640 non-Hispanic white patients (77.0%) and 7,956 African American/Black patients (23.1%) in the cohort. Black patients were less likely to undergo MT (adjusted odds ratio [OR], 0.65; 95% CI, 0.54–0.76), arrive within 5 hours of “last known well” (adjusted OR, 0.73; 95% CI, 0.69–0.78), and have documented anterior circulation large vessel occlusion (adjusted OR, 0.78; 95% CI, 0.64–0.96) in multivariable logistic regression. When patients with documented acute big vascular blockage arrived within 5 hours of their last known well, the race had no bearing on the MT rate. Because of longer periods from last known well to hospital arrival and a lower rate of verified acute major artery blockage, black patients with stroke underwent MT less frequently than White patients. More research was needed to determine if expanding the MT time window and using more aggressive big vascular occlusion screening techniques could have helped to close the gap.