To compare the efficacy and safety of direct mechanical thrombectomy (dMT) and intravenous thrombolysis bridging mechanical thrombectomy therapy (BT) in acute large vessel occlusion stroke within 6h of onset.Methods We retrospectively analyzed the clinical data of patients with acute large vessel occlusion stroke in our hospital from November 2019 to December 2020. The patients were divided into dMT group and BT group according to treated with different therapy.The clinical baseline data, safety and effectiveness indicators(incidence of intracranial hemorrhage, mortality, successful reperfusion, NIHSS scores at 24h, favorable functional outcome at 90d) were compared between the two group. In the sub-studies, the patients in the bridging group were divided into the alteplase bridging treatment group and the urokinase bridging treatment group according to the different thrombolytic agent, and the safety and effectiveness indexes between the two groups were analyzed. Results Baseline characteristics did not differ between the dMT and BT group (P＞0.05). The successful reperfusion rate, NIHSS scores at 24h, incidence of intracranial hemorrhage, mortality, and favorable functional outcome at 90d were not significantly different between the two group (P＞0.05). meanwhile our subgroup analysis showed that thrombolytic agents did not affect the primary and secondary outcomes of bridging therapy (P＞0.05). Conclusion The efficacy and safety of dMT and BT are similar for acute large vessel occlusion stroke within 6h of onset, there were not different in the safety and prognosis between urokinase bridging therapy and alteplase bridging therapy (P＞0.05).