Endovascular treatment (EVT) utilization rose after clinical trials were published in 2015, although little evidence suggests that race and ethnicity inequalities may persist. Researchers analyzed the relationship between race and ethnicity, EVT use, and outcomes in patients with acute ischemic stroke who arrived within 6 hours of last known well and had a National Institute of Health Stroke Scale (NIHSS) score of more than or equal to 6 between April 2012 and June 2019 in the Get With The GuidelinesStroke database, comparing the era before and after 2015. EVT was performed on 42,422 (14%) of the 3,02,965 theoretically eligible patients. Even though EVT usage rose over time in all racial and ethnic categories, Black patients had a lower rate of EVT use than non-Hispanic White (NHW) patients (aOR before 2015, 0.68 [0.58‒0.78]; aOR after 2015, 0.83 [0.76‒0.90]). In comparison to NHW, Black, Hispanic, and Asian patients had a lower in-hospital mortality and hospice discharge rate. In contrast to NHW patients, Hispanic (29.7%; aOR, 1.28 [1.16‒1.42]), Asian (28.2%; aOR, 1.23 [1.05‒1.44]), and Black (29.1%; aOR, 1.08 [1.00‒1.18]) patients were more likely to be discharged home (24%). Functional independence (modified Rankin Scale, 0–2) was less common in Black (37.5%; aOR, 0.84 [0.75‒0.95]) and Asian (33%; aOR, 0.79 [0.65‒0.98]) patients at 3 months than in NHW patients (38.1%). Disparities in EVT use between Black and NHW patients have lessened over time in a large cohort of EVT patients, but they still exist. Discharge-related results were marginally better in underrepresented racial and ethnic groups; 3-month functional outcomes were worse but improved with time in all groups.