In addition, there was a 16% reduction in risk of in-hospital death at institutions that used interventional therapies such as balloon angioplasty to treat arterial vasospasm.2,81,162 Therefore, hospital treatment vol- umes and availability of both endovascular and neurological intensive care services at hospitals are important determinants of improved outcomes in aSAH.163 In addition, a cost-utility analysis estimated that transferring a patient with aSAH from a low- to a high-volume hospital would result in a gain of 1.6 quality-adjusted life-years at a cost of $10 548.162,163 Although 1 study suggested that care was uniformly delivered within an institution when weekend and weekday admissions were compared,164 others have shown that inten- sive care specialists followed evidence-based recommenda- tions very inconsistently, and these variations in practice did not depend on the quality of the supporting data.165 Signifi- cant practice differences were noted between respondents from North America and Europe and between those working in high- and low-volume centers. Thus, the study demon- strated that the practices of intensive care unit physicians treating aSAH are heterogenous and often at variance with One recent effort to increase the uniformity of care is the development of an Accreditation Council on Graduate Med- ical Education approved fellowship training program for endovascular surgical neuroradiology.166 Another effort is legislation or regulation in 10 states that defines elements of comprehensive stroke centers and their role in networks and stroke systems of care. The Brain Attack Coalition paper that proposed the establishment of these centers included management of aSAH in its scope.167 From the endovascular perspective, this expertise includes the ability to treat patients with intracranial aneurysms, SAH-induced vasospasm, brain arteriovenous malformations, and ischemic stroke. Other important required elements of these centers are vascular neurosurgical expertise, dedicated intensive care units, and 24/7 access to advanced neuroimaging. 