Middle Meningeal Artery Embolization Feasible for Subdural Hematoma
MONDAY, Dec. 2, 2024 -- Middle meningeal artery embolization plus surgery is associated with a lower risk for hematoma recurrence or progression leading to reoperation than surgery alone among patients with symptomatic subacute or chronic subdural hematoma with an indication for surgical evacuation, according to a study published online in the Nov. 20 issue of the New England Journal of Medicine.
Jason M. Davies, M.D., Ph.D., from the University at Buffalo in New York, and colleagues conducted a prospective, interventional, adaptive-design trial involving patients with symptomatic subacute or chronic subdural hematoma with an indication for surgical evacuation. Patients were randomly assigned to undergo middle meningeal artery embolization plus surgery (treatment group; 197 patients) or surgery alone (control group; 203 patients).
Overall, 34.0 percent of the patients underwent surgery before being randomly assigned. The researchers found that hematoma recurrence or progression leading to repeat surgery occurred in 4.1 and 11.3 percent of patients in the treatment and control groups, respectively (relative risk, 0.36). Functional deterioration occurred in 11.9 percent of those in the treatment group and 9.8 percent in the control group. Mortality at 90 days was 5.1 and 3.0 percent in the treatment and control groups, respectively. Serious adverse events related to the embolization procedure had occurred in 2.0 percent of patients in the treatment group by 30 days; no additional events occurred by 180 days.
"The 90-day mortality appeared to be higher in the treatment group than in the control group (5.1 percent vs. 3.0 percent), but the difference was not attributed by independent assessors to the embolic agent or to the embolization procedure," the authors write.
Several authors disclosed ties to relevant organizations.
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