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To assess the independent effect of a treatment modality on CFRs, we investigated CFR changes in a high-volume center rapidly transitioning from surgical to endovascular operations as the first-line treatment for all aSAH patients except those with middle cerebral artery (MCA) aneurysms.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We identified all surgically\/endovascularly treated aSAH patients in Helsinki University Hospital (HUH) during 2012\u20132017. As the treatment shift occurred in 2015, we defined two treatment eras: surgical (2012\u20132014) and endovascular (2015\u20132017). We compared time-dependent changes in 1-year CFRs between non-MCA and MCA patients using a Poisson regression model. To analyze consistency in operation rates, we also identified sudden-death and conservatively treated aSAHs in the HUH catchment area via two externally validated registers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of all 665 hospitalized aSAH cases in the HUH catchment area, 557 (84%) received operative treatment; 367 (66%) underwent surgical and 190 (34%) endovascular operations. Between the treatment eras, endovascular treatment for non-MCA cases increased from 21 to 79%, whereas 99% of the MCA cases were treated surgically during the whole study-period. Among the operatively treated patients, the 1-year CFRs decreased similarly in patients with non-MCA (42%; from 14 to 8%; adjusted risk ratio (aRR)\u2009=\u20090.66 (95% CI 0.37\u20131.19)) and MCA aneurysms (42%; from 15 to 9%; aRR\u2009=\u20090.66 (0.16\u20131.60)). The proportion of operatively treated patients, their clinical condition on admission, and amount of bleeding on the first CT-scan remained unchanged over time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>We found similar CFR decreases in aSAH groups with and without undergoing a fast transition from surgery to endovascular operations, providing real-world evidence on the small independent effect of endovascular treatment on the decreasing CFRs in high-volume centers.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06447-1","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T23:49:26Z","timestamp":1738712966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Has a fast treatment transition from surgical to endovascular operations improved the survival of aneurysmal subarachnoid hemorrhage?"],"prefix":"10.1007","volume":"167","author":[{"given":"Aleksanteri","family":"Asikainen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilari","family":"Rautalin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Raj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miikka","family":"Korja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Niemel\u00e4","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"issue":"11","key":"6447_CR1","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/j.jocn.2010.03.024","volume":"17","author":"YZ Al-Tamimi","year":"2010","unstructured":"Al-Tamimi YZ, Ahmad M, May SE, Bholah MH, Callear J, Goddard A et al (2010) A comparison of the outcome of aneurysmal subarachnoid haemorrhage before and after the introduction of an endovascular service. 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This study was performed in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"In accordance with the Finnish legislation, the requirement to obtain patient consent was waived by all three institutions due to the secondary use of already-collected health data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}