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Objective Mechanical thrombectomy (MT) improves outcomes in acute ischemic stroke due to large vessel occlusion; however, the influence of social determinants of health (SDoH) on post-thrombectomy recovery among treated patients remains incompletely defined. We evaluated associations between neighborhood-level vulnerability, socioeconomic factors, geographic residence, and outcomes following MT.Methods We conducted a retrospective cohort study of consecutive adults undergoing MT at a comprehensive stroke center in the Mountain West from February 2018 to February 2024. Demographic, socioeconomic, clinical, imaging, procedural, and outcome variables were abstracted from the electronic health record. Neighborhood vulnerability was measured using the CDC Social Vulnerability Index (SVI). Primary outcomes included inpatient mortality, discharge to rehabilitation, hospital length of stay (LOS), good 90-day functional outcome (modified Rankin Scale [mRS] 0-2), and loss to follow-up (LTFU). Multivariable regression models adjusted for demographic, socioeconomic, geographic, and clinical severity variables, including NIHSS, ASPECTS, reperfusion status, treatment times, and complications.Results A total of 357 patients were included. On multivariable analysis, increasing age remained independently associated with inpatient mortality (OR 1.09 per year, p = 0.001) and with higher odds of LTFU (OR 1.03 per year, p = 0.045). Female sex was independently associated with discharge to rehabilitation (OR 2.25, p = 0.047), and married/partnered status was associated with shorter LOS (B = −0.281, p = 0.011). Out-of-state residence was independently associated with lower odds of good 90-day outcome (OR 0.29, p = 0.016) and higher odds of LTFU (OR 2.51, p = 0.007). SVI was not independently associated with any primary outcome after adjustment.Conclusions Among patients who underwent MT, neighborhood-level vulnerability was not independently associated with post-procedural outcomes. Instead, age, social support proxies, and geographic residence demonstrated more consistent associations with recovery and follow-up continuity. These findings suggest that, once access to thrombectomy is achieved, longitudinal care integration and regional continuity may play a greater role in durable recovery than area-level vulnerability alone.Disclosures I. Christie: None. C. Chugg: None. N. Kendall: None. A. Nyalundja: None.