Largevessel occlusion (LVO) strokesmay be eligible for treatment with intravenous thrombolysis(IVT)and endovascular therapy(EVT).Patients selected for treatment have better neurologic outcomes withEVT, anddelaysinthis therapyleadto worse outcomes. However, EVT is offered at a limited number ofhospitals,referred to asendovascular stroke centers (ESC).Thisposesa difficult decisionforEMS:to take potential stroke patients to the closestprimary stroke center (PSC)or longertransport time to a more distantESC. We hypothesized that patients with LVO stroke undergoing EVT transported directly to an ESC would have more favorable outcomes as measured by the modified Rankin scale (mRS) at 90 days, compared to transport to a PSC followed by transfer to an ESC. The OPUS-REACH consortium examinedtransportation patterns and outcomes in patients with LVO stroke who received endovascular treatment.This cohort includes 2400 patients with LVO stroke throughouteightendovascular centers in the Northeast U.S.from 2015 to 2020. All patients enrolled in the OPUS-REACH database were eligible for inclusion. Patients were excluded if they were missing the pickup address, had an in-hospital stroke, or arrived via mobile stroke unit. The remaining patients were separated into two groups: thebypass group, withtransportation by EMS to an ESCbybypassing PSC,andthe non-bypassgroup, withinitialtransport to PSCandinterfacility transport to an ESC.The primary outcome was the modified Rankin scale(mRS)at 90 days, where 0-2 was defined as "good". The primary outcome did not reach significancewith 40% of the bypass group as compared with the 33.1% of thenon-bypassgroup having a "good" outcome. However, the bypass group underwent shorter times from last-known-well to both thrombolysis (120.9 vs 153.3 min, p < 0.001) and thrombectomy (356.1 vs 454.8 min, p = 0.001). In patients with LVO stroke who undergo thrombectomy, EMS transport directly to an ESC results in shorter time thrombectomy, although we did not observe a difference in 90-day functional outcomes. Additionally, bypass to reach a more capable endovascular stroke center does not delay administration of IVT from time of LKW.