Association of cerebrovascular center volume with patient outcomes

Current guidelines acknowledge the importance of both microsurgical and neuroendovascular expertise in the treatment of cerebrovascular disease. To achieve optimal care for these patients, it is becoming increasingly evident that procedural volumes impact patient outcomes. This is demonstrated across various cerebrovascular diseases.In this literature review, we demonstrate the association of volume with patient outcomes across multiple cerebrovascular disease states and interventions. Microsurgical aneurysm clipping remains essential even with the rise of endovascular therapy and mortality and patient-safety indicator events are clearly lower at high-volume centers for both ruptured and unruptured aneurysms. Likewise, patients undergoing surgery for cerebrovascular malformations and carotid endarterectomy have significantly better outcomes in high-volume centers by high-volume surgeons. Studies of mechanical thrombectomy and carotid stenting reinforce the association between higher procedural volumes, decreased mortality, and improved outcomes across various intervention modalities. The integration of neurocritical care has further improved outcomes, with specialized units demonstrating reduced mortality rates and lengths of stay.Modern cerebrovascular and stroke care necessitates comprehensive care by experienced providers in high-volume centers to optimize patient outcomes for both hemorrhagic and ischemic cerebrovascular disease. The relationship between higher institutional and provider case volumes and better patient outcomes is clearly delineated in the literature. Maintaining high-volume standards for endovascular and microsurgical cerebrovascular care can help ensure high-quality care across centers.