Other important required elements of these centers are vascular neurosurgical expertise, dedicated intensive care units, and 24/7 access to advanced neuroimaging. The rationale for comprehensive stroke centers is based on the success of similar models for trauma. Hospital Characteristics and Systems of Care: Recommendations 1. Low-volume hospitals (eg, <10 aSAH cases per year) should consider early transfer of patients with aSAH to high-volume centers (eg, >35 aSAH cases per year) with experienced cerebrovascular sur- geons, endovascular specialists, and multidisci- plinary neuro-intensive care services (Class I; Level of Evidence B). (Revised recommendation from previ- ous guidelines) 2. Annual monitoring of complication rates for surgical and interventional procedures is reasonable (Class IIa; Level of Evidence C). (New recommendation) 3. A hospital credentialing process to ensure that proper training standards have been met by indi- vidual physicians treating brain aneurysms is reasonable (Class IIa; Level of Evidence C). (New recommendation) Anesthetic Management During Surgical and Endovascular Treatment The general goals of anesthetic management involve hemo- dynamic control to minimize the risk of aneurysm rerupture and strategies to protect the brain against ischemic injury. 