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Published on: October 15, 2021
Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma: A Meta-Analysis of Large Randomized Controlled
Huanwen Chen1, Matthew K McIntyre2, Peter Kan3
1From the Department of Neurology (H.C.), MedStar Georgetown University Hospital, Washington, DC.
Background:
Middle meningeal artery embolization (MMAE) has emerged as a novel treatment for non-acute subdural hematoma (SDH), particularly for reducing the risk of SDH recurrence. Recently, 5 randomized controlled trials (RCTs) of MMAE as an adjunct to conventional management (surgical or observant) have concluded their investigation and reported their outcomes.
Purpose:
Our goal was to synthesize trial results to provide more definitive guidance on the role of MMAE in the management of non-acute SDH.
Data Sources:
The MEDLINE database from inception up to November 23, 2024 was used. English-language clinical articles reporting large randomized controlled trials (n = 100 or more) investigating the efficacy and safety of MMAE for patients with non-acute subdural hematoma were identified.
Study Selection:
Five trials were identified-EMBOLISE, STEM, MAGIC-MT, EMPROTECT, and MEMBRANE.
Data Analysis:
The primary efficacy end point was SDH treatment failure (broadly defined as SDH recurrence or requirement of surgical rescue) within 3 to 6 months. Safety end points include death and stroke.
Data Synthesis:
There was significant heterogeneity in terms of patient populations as well as reported outcomes. Overall, MMAE was associated with significantly lower odds of SDH treatment failure (OR 0.51 [95% CI 0.39-0.67], P < .001), with minimal inter study heterogeneity. Compared with conventional management, MMAE was not significantly associated with different odds of death (OR 1.03 [95% CI 0.36-2.99], P = .95) or stroke (OR 1.10 [95% CI 0.36-3.39], P = .86).
Limitations:
Our meta-analysis is limited by selection bias and high heterogeneity in study design and reported outcomes.
Conclusions:
This study provides high-level evidence that, for patients with non-acute SDH, MMAE is a safe and effective adjunct to conventional management for preventing treatment failure.
