Stroke patients with large vessel occlusion (LVOS) are mainly admitted in primary stroke centres (PSC), which delays treatment and reduces their chances of receiving endovascular thrombectomy (EVT). This results in worsened outcomes, highlighting the need to decentralize and optimize EVT services through thrombectomy–capable stroke centers (TSCs).

We retrospectively analyzed data from patients treated at Perpignan Stroke Center, which transitioned through three phases: as a PSC, then as a limited-hours TSC and as a full-time 24/7 TSC. Patients with standard LVOS admitted within 24 h of symptom onset and without prior disability were included. A long-term Markov model and environmental cost evaluations were used to assess the nationwide clinical, economic, and environmental impact of TSCs.

Of the 788 patients, 367 were treated in the PSC setting and 421 in the TSC setting (222 limited-hours , 199 full-time 24/7). Patients in the TSC group had shorter onset-to-recanalization times, higher rates of excellent outcome (mRS 0–1 aOR 1.50 .[1.07–2.09]; p = 0.019 ) and were more likely to be discharged within 7 days. From a healthcare system perspective, TSCs were associated with a negative incremental cost–effectiveness ratio (ICER) of €10,621 per quality–adjusted life–years (QALY). Probabilistic sensitivity analyses showed all simulations remained within the favorable cost-effectiveness quadrant. Environmentally, transfer reductions avoided 50.3–70.8 t of CO₂ emissions annually.

Using TSCs improves clinical outcomes, may induce long–term projected economic value to the national healthcare system, and potentially environmental sustainability. These findings support their integration, even without full-time capacity, into stroke care strategies to optimize patient outcomes and resource allocation.