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Background Mechanical thrombectomy (MT) significantly improves outcomes in patients with acute ischemic stroke due to large vessel occlusion. There is limited understanding of how the site of hospital readmission after MT influences patient outcomes. Addressing this gap may be important for optimizing post-MT care and improving long-term outcomes for stroke patients.Methods We conducted a retrospective cohort analysis using data from the Nationwide Readmissions Database, focusing on acute ischemic stroke patients who underwent MT between 2016 and 2019. Multivariable Cox regression and Fine and Gray competing risks models were used to assess the impact of readmission site on patient outcomes, including mortality and the likelihood of discharge to home.Results The analysis included 18 330 patients readmitted within 90 days post-MT, with 63.7% readmitted to index hospitals and 36.3% to non-index hospitals. Readmission to the index hospital was not significantly associated with mortality but was linked to a higher likelihood of discharge to home (subdistributed HR 1.22, 95% CI 1.13 to 1.32, P<0.001), a lower likelihood of longer hospital stay (OR 0.81, 95% CI 0.72 to 0.90, P<0.001), and lower hospital cost (β = −3345.25, 95% CI −5786.46 to −904.04, P=0.007).Conclusion This nationwide analysis suggests that for acute ischemic stroke patients treated with MT, readmission to index hospitals within 90 days is associated with a higher likelihood of home discharge, shorter length of stay, and lower hospital cost. Further research is warranted to better understand the underlying causes of these disparities and to enhance continuity of care for this vulnerable patient population.