Variability of Clinical and Angiographic Results based on the Treatment Preference (Endovascular or Surgical) of Centers Participating in the Subarachnoid Hemorrhage Database of the Working Group of the Spanish Society of Neurosurgery

Abstract Background Since the introduction of endovascular treatment for cerebral aneurysms, hospitals in which subarachnoid hemorrhage is treated show different availability and/or preferences towards both treatment modalities. Objectives The main aim is to evaluate the clinical and angiographic results according to the hospital’s treatment preferences applied. Materials and methods This study was conducted based on use of the subarachnoid hemorrhage database of the Vascular Pathology Group of the Spanish Neurosurgery Society. Centers were classified into three subtypes according to an index in the relationship between endovascular and surgical treatment as: Endovascular preference, high endovascular preference, and elevated surgical preference. The clinical results and angiographic results were evaluated among the three treatment strategies. Results From November 2004 to December 2017, 4282 SAH patients were selected for the study: 630 (14.7%) patients from centers with surgical preference, 2766 (64.6%) from centers with endovascular preference, and 886 (20.7%) from centers with high endovascular preference. The surgical preference group obtained the best angiographic results associated with a greater complete exclusion (OR 1.359; 95%CI 1.025-1.801; p=0.033). The surgical preference subgroup obtained the best outcome at discharge (65.45%), followed by high endovascular preference (61.5%) and endovascular preference (57.8%) (OR 1.359; 95%CI 1.025-1.801; p=0.033). Conclusions In Spain, there is significant variability in aneurysm exclusion treatment in aneurysmal subarachnoid hemorrhage. Surgical centers offer better results for both surgical and endovascular patients. A multidisciplinary approach and the maintenance of an elevated quality of surgical competence could be responsible for these results.