Normally cisco sells via resellers in Europe, although you can get SmartNet contracts anywhere aUS company can send an engineer (which are much more about hardware swap).
AFAIK the only exceptions are users that insist otherwise (which often means they dont get good support since Cisco seems to only be set up for direct sales in the US), or are US based, or a telco (which probably equates to more like $1m / yr+)
and they check up with the reseller customers to make sure that the reseller looks after their customers, has support staff, CCIEs and so on.
And if the reseller consistently does badly on the feedback they will lose accreditation = discount, access to TAC etc - which means their Cisco business just goes away.