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Published on: January 17, 2013
Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Predictors of Clinical and Radiographic Failure
Mohamed M Salem1, Okkes Kuybu1, Alex Nguyen Hoang1
1From the Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104 (M.M.S., B.T.J., J.K.B.); Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pa (O.K., A.A.M., S.N., M.J.L., B.A.G.); Department of Neurosurgery, Baylor College of Medicine, Houston, Tex (A.N.H., O.T., P.K.); Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (A.A.B., J.M.D., E.I.L., A.H.S.); Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Mass (M.K., J.M.M., C.S.O., A.J.T.); Department of Neurosurgery, University of Utah, Salt Lake City, Utah (C.B., J.C.H., R.G.); Department of Cerebrovascular and Endovascular Surgery, Baptist Neurologic Institute and Lyerly Neurosurgery, Jacksonville, Fla (G.C., R.H.); Department of Neurosurgery, Emory University School of Medicine, Atlanta, Ga (C.M.C., B.M.H.); Department of Neurosurgery, NYU Langone Medical Center, New York, NY (H.A.R.); Department of Neurosurgery, Medical University of South Carolina, Charleston, SC (A.M.S.); Department of Neurosurgery, University of California-San Diego, La Jolla, Calif (A.A.K.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.K.); and Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ (A.J.T.).
Abstract:
Background Knowledge regarding predictors of clinical and radiographic failures of middle meningeal artery (MMA) embolization (MMAE) treatment for chronic subdural hematoma (CSDH) is limited. Purpose To identify predictors of MMAE treatment failure for CSDH. Materials and Methods In this retrospective study, consecutive patients who underwent MMAE for CSDH from February 2018 to April 2022 at 13 U.S. centers were included. Clinical failure was defined as hematoma reaccumulation and/or neurologic deterioration requiring rescue surgery. Radiographic failure was defined as a maximal hematoma thickness reduction less than 50% at last imaging (minimum 2 weeks of head CT follow-up). Multivariable logistic regression models were constructed to identify independent failure predictors, controlling for age, sex, concurrent surgical evacuation, midline shift, hematoma thickness, and pretreatment baseline antiplatelet and anticoagulation therapy. Results Overall, 530 patients (mean age, 71.9 years ± 12.8 [SD]; 386 men; 106 with bilateral lesions) underwent 636 MMAE procedures. At presentation, the median CSDH thickness was 15 mm and 31.3% (166 of 530) and 21.7% (115 of 530) of patients were receiving antiplatelet and anticoagulation medications, respectively. Clinical failure occurred in 36 of 530 patients (6.8%, over a median follow-up of 4.1 months) and radiographic failure occurred in 26.3% (137 of 522) of procedures. At multivariable analysis, independent predictors of clinical failure were pretreatment anticoagulation therapy (odds ratio [OR], 3.23; P = .007) and an MMA diameter less than 1.5 mm (OR, 2.52; P = .027), while liquid embolic agents were associated with nonfailure (OR, 0.32; P = .011). For radiographic failure, female sex (OR, 0.36; P = .001), concurrent surgical evacuation (OR, 0.43; P = .009), and a longer imaging follow-up time were associated with nonfailure. Conversely, MMA diameter less than 1.5 mm (OR, 1.7; P = .044), midline shift (OR, 1.1; P = .02), and superselective MMA catheterization (without targeting the main MMA trunk) (OR, 2; P = .029) were associated with radiographic failure. Sensitivity analyses retained these associations. Conclusion Multiple independent predictors of failure of MMAE treatment for chronic subdural hematomas were identified, with small diameter (<1.5 mm) being the only factor independently associated with both clinical and radiographic failures. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Chaudhary and Gemmete in this issue.
