Garrett W Thrash, Bluyé DeMessie, Elijah L Wang, Jesse G Jones, Muhammed Amir Essibayi, Hamza Adel Salim, Alireza Karandish, Deepak Khatri, Neil Haranhalli, Amanda Baker, Richard Zampolin, Allan L Brook, Seon-Kyu Lee, Nimer Adeeb, Dhairya A Lakhani, Yan-Lin Li, Davide Simonato, Diego Alejandro Ortega, Nicole Cancelliere, Jose Danilo Diestro, Joseph Carnevale, Craig Schreiber, Atakan Orscelik, Zachary Abecassis, Spencer Raub, Georgios S Sioutas, Abdulrhman Alsalama, Clairice Pearce, Giancarlo Salsano, Rahim Abo Kasem, Svetlana Kvint, Andrew Falzon, Vance Cantrell, Brian Holliday, Jefferson O Abaricia, Pedram D Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Jorge Rios Zermeno, Prateeka Koul, Ahmed Aljuboori, Dominik F Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, James Grist, Fulvio Zaccagna, Christopher S Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A Möhlenbruch, Luca Scarcia, William W Wroe, Hussein A Zeineddine, Si Zhao Tang, Peter B Sporns, Anil Gopinathan, Robert W Regenhardt, Spiros L Blackburn, Clemens M Schirmer, Thien Huynh, Rabih G Tawk, Fabio Settecase, Stavropoula Tjoumakaris, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Marco Colasurdo, Hussein H Nasser, Sri Hari Sundararajan, Pascal J Mosimann, Erez Nossek, Eytan Raz, Sami Al Kasab, Alejandro M Spiotta, Lucio Castellan, Bruno Del Sette, Ali Alaraj, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M Srinivasan, Jan-Karl Burkhardt, Gaultier Marnat, Pietro Mario Santini, Michael R Levitt, Giuseppe Lanzino, Waleed Brinjikji, Jared Knopman, Tareq Kass-Hout, Julian Spears, Thomas Marotta, Vitor Mendes Pereira, Maurizio Fuschi, Tufail Patankar, David J Altschul, Adam A Dmytriw
Future, multi-center randomized prospective trials are warranted to address confounding variables that limit this observational study. Follow-up beyond 3 months was limited, so durability is unknown.
INTRODUCTION: Nonacute subdural hematomas (nSDH) are common yet serious extra-axial hemorrhages that result in significant morbidity and mortality. Middle meningeal artery (MMA) embolization (MMAE) is a recent endovascular treatment that involves occlusion of the MMA, inducing hemostasis in and around the hematoma. While many aspects of MMAE have been explored, there is currently limited data on the optimal extent of embolization.
OBJECTIVE: To determine whether single or multiple pedicle embolization of the MMA is superior in inducing hemostasis in nSDH.
METHODS: We compared single versus multi pedicle embolization by a retrospective multicenter analysis of nSDH patients who underwent MMAE between 2019 and 2024 at participating centers in the MESH (MMA Embolization for Subdural Hematoma) Registry. 679 patients who received a liquid embolic agent with branch-level embolization data were included.
RESULTS: While multi-pedicle embolization hastened nSDH thinning at 1 month (5.7 vs. 3.3 mm reduction; difference 2.4 mm, 95% CI 1.0-3.8; P = .002), by 3 months thickness reduction had converged between groups (8.2 vs. 8.4 mm; P = .91). Among 679 patients (456 multi-pedicle, 223 single-pedicle), favorable functional outcome (mRS 0-2) was more frequent with multi-pedicle embolization (53.5% vs. 43.0%; adjusted OR 1.81, 95% CI 1.26-2.60; P = .001), whereas recurrence, rescue surgery, and treatment failure did not differ.
CONCLUSION: Future, multi-center randomized prospective trials are warranted to address confounding variables that limit this observational study. Follow-up beyond 3 months was limited, so durability is unknown.