Meningeal Embolization for Preventing Chronic Subdural Hematoma Recurrence After Surgery: The EMPROTECT Randomized...

Area of Science:

• Neurosurgery and Interventional Neuroradiology
• Vascular Interventions
• Neurological Surgery

Background:

• Chronic subdural hematoma (CSH) is a significant clinical challenge, with recurrence posing a risk after surgical evacuation.
• Middle meningeal artery (MMA) embolization has emerged as a potential adjunctive therapy to reduce CSH recurrence.

Purpose of the Study:

• To evaluate the efficacy of MMA embolization in decreasing the 6-month recurrence rate of CSH in patients who underwent surgery.
• To compare MMA embolization plus standard care against standard care alone in high-risk CSH patients.

Main Methods:

• A multicenter, open-label, randomized clinical trial involving 342 patients at high risk for CSH recurrence.
• Participants were randomized to receive MMA embolization with microparticles within 7 days of surgery or standard medical care.
• The primary outcome was CSH recurrence at 6 months, assessed by a blinded adjudication committee.

Main Results:

• The 6-month CSH recurrence rate was 14.8% in the MMA embolization group and 21.0% in the standard care group (P=.13).
• No significant differences were observed between groups for secondary endpoints, including repeat surgery rates.
• Embolization procedure-related complications were low (1.8% minor, 0.6% major).

Conclusions:

• MMA embolization did not significantly lower the CSH recurrence rate at 6 months compared to standard care in this trial.
• The observed effect size is consistent with other trials, suggesting potential utility that warrants further investigation.
• Findings may inform future studies on MMA embolization for CSH management, particularly with different embolic agents.