• Fuat Arikan, Nacho Errando, Alfonso Lagares, Darío Gándara, Andreu Gabarros, Pablo López-Ojeda, Javier Ibáñez, Marta Brell, Pedro A Gómez, Jose A Fernández-Alén, Jesús Morera, Angel Horcajadas, Vicente Vanaclocha, José L Llácer, Elena Baño-Ruiz, Jesús M Gonçalves-Estella, Ramon Torné, Jhon A Hoyos, Rosario Sarabia, Ignacio Arrese, Gregorio Rodríguez-Boto, de la Lama Adolfo A Neurosurgery Department, Complejo Hospitalario de Vigo, Vigo, Spain., Jaime Domínguez, Rubén Martín-Láez, David Santamarta-Gómez, Pedro D Delgado-López, Luís Ley-Urzaiz, Olga Mateo, Begoña Iza, Javier Orduna-Martínez, Francisco de Asís Lorente-Muñoz, Fernando Muñoz-Hernández, Jone Iglesias, and Jordi Vilalta.
• Neurosurgery Department, University Hospital Vall d'Hebron, Barcelona, Spain; Neurotraumatology-Neurosurgery Research Unit (UNINN), Research Institute Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: farikan@vhebron.net.
• World Neurosurg. 2020 Mar 1; 135: e339-e349.

ObjectivesSince 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. The main aim is to evaluate the clinical and angiographic results according to the hospital's treatment preferences applied.MethodsThis 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 3 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 3 treatment strategies.ResultsFrom November 2004 to December 2017, 4282 subarachnoid hemorrhage 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 (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). The surgical preference subgroup obtained the best outcome at discharge (65.45%), followed by the high endovascular preference group (61.5%) and the endovascular preference group (57.8%) (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033).ConclusionsIn 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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