While endovascular treatment (ET) improves clinical outcomes in patients with proximal vessel occlusions compared to thrombolysis (IVT), the impact of ET on the frequency of stroke-associated pneumonia (SAP) is uncertain. We compared the rates of SAP in patients with large vessel occlusions in the anterior circulation after IVT or ET. We also determined risk factors for SAP, as well as the impact of SAP on early clinical outcomes. A total of 544 patients were treated with IVT, and 1061 patients received ET (with or without IVT). The rates of SAP did not differ significantly between ET (217/1061; 20%) and IVT (100/544; 18%) (p = 0.3). Overall, the occurrence of SAP was significantly associated with mortality and a poor clinical outcome. In the multivariable regression analysis, age, sex, the presence of dysphagia, early signs of ischemia on imaging and a history of stroke and mechanical ventilation were all significantly associated with the occurrence of SAP. In patients with large vessel occlusions, the introduction of ET did not result in lower rates of SAP compared with IVT. There is an ongoing need to reduce the rates of SAP in this patient population, for which the risk factors found here could become useful.