Radiographic and clinical outcomes with particle or liquid embolic agents for middle meningeal artery embolization of nonacute subdural hematomas

Abstract

Background Middle meningeal artery (MMA) embolization is an apparently efficacious minimally invasive treatment for nonacute subdural hematomas (NASHs), but how different embolisates affect outcomes remains unclear. Our objective was to compare radiographic and clinical outcomes after particle or liquid MMA embolization. Methods Patients who had MMA embolization for NASH were retrospectively identified from a multi-institution database. The primary radiographic and clinical outcomes—50% NASH thickness reduction and need for surgical retreatment within 90 days, respectively—were compared for liquid and particle embolizations in patients treated 1) without surgical intervention (upfront), 2) after recurrence, or 3) with concomitant surgery (prophylactic). Results The upfront, recurrent, and prophylactic subgroups included 133, 59, and 16 patients, respectively. The primary radiographic outcome was observed in 61.8%, 61%, and 72.7% of particle-embolized patients and 61.3%, 55.6%, and 20% of liquid-embolized patients, respectively (p = 0.457, 0.819, 0.755). Hazard ratios comparing time to reach radiographic outcome in the particle and liquid groups or upfront, recurrent, andprophylactic timing were 1.31 (95% CI 0.78–2.18; p = 0.310), 1.09 (95% CI 0.52–2.27; p = 0.822), and 1.5 (95% CI 0.14–16.54; p = 0.74), respectively. The primary clinical outcome occurred in 8.0%, 2.4%, and 0% of patients who underwent particle embolization in the upfront, recurrent, and prophylactic groups, respectively, compared with 0%, 5.6%, and 0% who underwent liquid embolization (p = 0.197, 0.521, 1.00). Conclusions MMA embolization with particle and liquid embolisates appears to be equally effective in treatment of NASHs as determined by the percentage who reach, and the time to reach, 50% NASH thickness reduction and the incidence of surgical reintervention within 90 days.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review

“…32 Since this 2017 report, there has been an explosion of interest in MMAE for cSDH with concomitant increase in publications on the procedure with a variety of study methodologies, different patient selection criteria, varied procedural techniques, embolysates, and unstandardized clinical and radiographic outcome analyses. [33][34][35][36][37][38][39][40] The relatively small sample sizes and the heterogeneity of these studies have hampered the interpretation of their findings and limited their generalizability.…”

“…The retrospective data which are available currently do not offer advantage of one embolic agent over the other, for either safety or efficacy. 40…”

Volumetric resolution of chronic subdural hematomas treated with surgical evacuation versus middle meningeal artery embolization during immediate, early, and late follow up: propensity-score matched cohorts

“…Middle meningeal artery embolization (MMAE) is increasingly being used to treat cSDH, especially in patients with recurrent cSDH and in those who are unable to undergo traditional surgical evacuation 6–9. It is hypothesized that MMAE could be effective as a standalone primary treatment because it is thought to mitigate the inflammatory response, and thus the accumulation of subdural fluid, by reducing the blood flow to dural membranes 3.…”

Automated Preoperative and Postoperative Volume Estimates Risk of Retreatment in Chronic Subdural Hematoma: A Retrospective, Multicenter Study

“…7,14,15 More recently, middle meningeal artery (MMA) embolization has been shown to be a safe and effective treatment, often as an adjunct to surgery, with failure rates between 4% and 9%. 16-27…”

“…7,14,15 More recently, middle meningeal artery (MMA) embolization has been shown to be a safe and effective treatment, often as an adjunct to surgery, with failure rates between 4% and 9%. [16][17][18][19][20][21][22][23][24][25][26][27] Volumetric measurements are frequently used to establish end points in clinical trials ranging from hemorrhagic stroke to glioblastoma surgery. [28][29][30][31][32][33][34][35] For cSDH, there are several advantages of using volume measurements vs the traditional method of measuring cSDH thickness.…”