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Introduction The Swedish National Endovascular Stroke Registry (EVAS), now in its jubilee year, covers 99% of all thrombectomy procedures nationwide—making it one of the most complete registries globally. Its comprehensive data allow for evaluation not only of procedural efficacy, but also of system-wide effectiveness, reflecting real-world access and equity in stroke care.Aim of Study To present national performance trends in mechanical thrombectomy, identify key regional disparities using a standardized KPI framework, and outline ongoing registry modernization and network expansion.Method A nationwide analysis of all EVT cases in EVAS was conducted using a dual-layered KPI model. Efficacy metrics included reperfusion success (mTICI ≥2b), complication rate, door-to-groin and onset-to-groin times, and direct triage rate. Effectiveness was evaluated using the EVT-to-AIS ratio and population success rate, combining treatment access with procedural outcome. In parallel, the registry is undergoing a platform migration to INCA—designed to streamline data capture, support structured reporting, and enable real-time feedback. Region Stockholm has now been fully integrated into the EVAS network.Results National KPI trends show steady improvement, yet regional disparities persist. Progressive centers demonstrate notably higher population-level impact. Platform modernization is ongoing and aligned with broader national standardization goals.Conclusion EVAS illustrates how KPI-driven benchmarking can shift stroke care from individual success to population-level performance. With modernization and full regional integration, Sweden is positioned to deliver faster, fairer, and more effective stroke treatment nationwide.Conflict of Interest No