Clinical Results and Costs of Endovascular Treatment in Comparison with Surgery in Subarachnoid Aneurismatic Hemorrhage (aSAH)

Background: Endovascular (EV) treatment of aSAH has increased in the last 20 years. Results of surgical (SC) and endovascular treatments are comparable, but EV has higher rates of retreatments. The cost of endovascular devices is high and makes this treatment expensive. Object: To evaluate the results and costs of surgical treatment against endovascular in SAH. Methods: Retrospective review of SAH patients was conducted, treated endovascularly (EV) and surgically (SC). A descriptive study of demographic, clinical and radiological aspects have been carried out. Clinical and angiographic results and economic costs have been evaluated in both globally, and in each of the groups. Results: 231 patients were reviewed (82.5% EV; 17.5% SC). A 71.2% of the patients presented favorable GOS (4-5) at 6 months (80% SC; 69, 3% EV). Mortality was 7,9% (all in SV group). The angiographic results were better in the SC group (88.6% of complete occlusion versus 50%), as well as the stability of the treatment (19.5% of retreatments versus 0%). The Average Length of Stay (ALOS) was higher in the SC group, however, overall costs after follow-up and retreatment were 12.3% higher in the EV group. Conclusion: Clinical results are comparable. The rate of complete occlusion of the SC group was higher and the need for retreatment lower. Costs of the EV group were significantly higher than the SC group due to the follow up and the rate of retreatment. Adequate selection of candidates for endovascular coiling could improve angiographic outcomes and save costs.