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Background: Direct oral anticoagulants (DOACs) are increasingly being prescribed. Compliant patients are excluded from iv-tPA and solely rely on mechanical thrombectomy for revascularization. DOAC-use may be related to development of small emboli causing distal occlusions potentially inaccessible for mechanical thrombectomy. We aimed to assess patientsu2019 eligibility for mechanical thrombectomy and risk of post-procedure hemorrhage in acute stroke patients on DOACs compared to those not on DOACs. Methods: For this retrospective single-center study on prospectively collected data, we selected consecutive acute stroke patients presenting between 2016-2018. We compared the relative frequency of distal occlusions (second order vessel segments and beyond), mechanical thrombectomy, and post-procedure intracerebral hemorrhage for DOAC-users and non DOAC-users using Chi-square.Results: 60/499 (12%) acute stroke patients were on a DOAC and 439/499 (88%) were not on a DOAC (mean NIHSS 13 and 11 respectively, p=0.15). 38/60 (63%) DOAC-users had an intracranial occlusion versus 252/439 (57%) of the non DOAC-users (p=0.38). Thirty DOAC-users (50%) had a proximal occlusion compared to 160/439 non DOAC-users (36%, p=0.04). 23/60 (38%) DOAC-users underwent mechanical thrombectomy versus 139/439 (32%) non DOAC-users (p=0.21). None of the DOAC-users and two of the non DOAC-users had post-procedure intracerebral hemorrhage (p=0.49). The mean 24h-NIHSS was similar for DOAC-users as for non DOAC-users (9 and 8 respectively, p=0.72).Conclusion: DOAC-users have more often a proximal occlusion than non DOAC-users with a similar proportion of patients being offered mechanical thrombectomy, though with a tendency towards a lower risk of post-procedure intracerebral haemorrhage.