Impact of middle meningeal artery embolisation on management of chronic subdural haematoma in older people with frailty and antithrombotic therapy

Background Middle meningeal artery embolisation (MMAE) is a potential adjunct/alternative to conventional treatment of chronic subdural haematoma (cSDH) and is associated with reduced rates of recurrence and surgical rescue. However, real world reporting outcomes in older people with frailty have not yet been extensively described.Methods We undertook an observational analysis of all cSDH patients requiring intervention between November 2019 and December 2024. Patients received either MMAE (standalone/adjunctive) or burr holes alone.Results Ninety patients underwent MMAE (median age: 81, IQR: 76–86); 222 underwent burr holes alone (median age: 80, IQR: 74–85). MMAE was adjunctive in 64.4% of cases; these patients had more severe neurological impairment, larger haematoma depth, and greater degree of midline shift than patients undergoing standalone MMAE. 52.2% of MMAE patients had frailty. MMAE was associated with significantly reduced cSDH recurrence (7.8% vs. 19.8%, p = 0.009, OR 0.341 (95% CI 0.136–0.745)), and antithrombotic therapy was resumed earlier in patients treated with MMAE (8.5 vs. 14 days, p < 0.001). Adverse events following MMAE were low (1.1%).Conclusions In a real-world UK healthcare setting, including patients with frailty, MMAE is associated with reduced rates of clinically significant cSDH recurrence and may facilitate safer, earlier reintroduction of antithrombotic therapy.