Although data on the outcomes of endovascular therapy (EVT) for acute ischemic stroke in different stroke centers are limited, this study aimed to evaluate EVT quality and outcomes in thrombectomy-capable stroke centers (TSCs) versus comprehensive stroke centers (CSCs) for ischemic stroke patients with large vessel occlusion.This study included 37 stroke centers (11 CSCs, 26 TSCs) dispersed across 20 provinces. Patients with acute anterior circulation large vessel occlusion within 24 hours of symptom onset were enrolled. Regression models were used to control for baseline characteristics and time metrics to assess outcomes by center type.A total of 947 patients (423 from TSCs, 524 from CSCs; median age: 69 years; 585 [61.8%] men) who underwent EVT were analyzed. Functional independence (modified Rankin Scale score [mRS] 0-2 at 90 days) was 43.5% in TSCs and 49% in CSCs (adjusted odds ratio [aOR], 1.02; 95% CI, 0.693-1.5). Compared to TSCs, CSCs exhibited lower mortality (aOR, 0.466; 95% CI, 0.284-0.767) and higher rates of successful reperfusion (aOR, 3.29; 95% CI, 1.76-6.15). No significant differences were found in terms of symptomatic intracranial hemorrhage or procedural complications. Sensitivity and subgroup analyses supported these findings.In patients with anterior circulation large vessel occlusion undergoing EVT, CSCs had similar functional independence rates to TSCs but lower mortality and better reperfusion without higher hemorrhage risk.© 2025. Fondazione Società Italiana di Neurologia.