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

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. The main aim is to evaluate the clinical and angiographic results according to the hospital...

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Published in:	World neurosurgery Vol. 135; pp. e339 - e349
Main Authors:	Arikan, Fuat, Errando, Nacho, Lagares, Alfonso, Gándara, Darío, Gabarros, Andreu, López-Ojeda, Pablo, Ibáñez, Javier, Brell, Marta, Gómez, Pedro A., Fernández-Alén, Jose A., Morera, Jesús, Horcajadas, Angel, Vanaclocha, Vicente, Llácer, José L., Baño-Ruiz, Elena, Gonçalves-Estella, Jesús M., Torné, Ramon, Hoyos, Jhon A., Sarabia, Rosario, Arrese, Ignacio, Rodríguez-Boto, Gregorio, de la Lama, Adolfo, Domínguez, Jaime, Martín-Láez, Rubén, Santamarta-Gómez, David, Delgado-López, Pedro D., Ley-Urzaiz, Luís, Mateo, Olga, Iza, Begoña, Orduna-Martínez, Javier, de Asís Lorente-Muñoz, Francisco, Muñoz-Hernández, Fernando, Iglesias, Jone, Vilalta, Jordi
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2020
Subjects:	Adult Aged Clip Coil Databases, Factual Endovascular Procedures - methods Endovascular treatment Female Hospital practice variation Humans Intracranial aneurysm Intracranial Aneurysm - surgery Male Middle Aged Neurosurgical Procedures - methods Subarachnoid hemorrhage Subarachnoid Hemorrhage - surgery Surgery Surgical Instruments Treatment Outcome Endovascular treatment Subarachnoid hemorrhage SENEC GOS Coil Clip CT Intracranial aneurysm Surgery GCS Hospital practice variation SAH WFNS
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Summary:	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. The main aim is to evaluate the clinical and angiographic results according to the hospital's treatment preferences applied. 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 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. From 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). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1878-8750 1878-8769
DOI:	10.1016/j.wneu.2019.11.163