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Proximal coiling versus liquid agents in treatment for middle meningeal artery embolization: A single-center study
Yigit Can Senol1, Bige Sayin2, Halis Emre Cifci3
1University of California San Francisco, Department of Neurosurgery, San Francisco, USA; Bilkent City Hospital, Department of Neurosurgery, Ankara, Turkiye.
Background And Objectives:
Middle meningeal artery (MMA) embolization has emerged as a promising stand-alone or adjunctive treatment for chronic subdural hematoma (cSDH). The choice of embolic material, such as proximal coiling or liquid agents, may influence procedural outcomes and complication rates. This study compares clinical and radiological outcomes between the two endovascular techniques.
Methods:
A retrospective analysis of consecutive cases of MMA embolization using proximal coiling or liquid agents was conducted from a prospectively maintained. Patient demographics, cSDH characteristics, clinical outcomes (admission vs. 90-day follow-up), radiological outcomes (midline shift, SDH width, fluoroscopy time), and periprocedural events were compared.
Results:
The study cohort included 94 patients with 114 cSDH. Subdural hematoma characteristics showed no significant differences, including laterality, maximum width, and midline shift. Stand-alone embolization constituted the majority of cases (83.3 %), with adjunct procedures performed in 16.7 %, showing no statistical difference between groups. Clinical outcomes at 90-day follow-up revealed no significant differences in modified Rankin Scale (mRS) scores, with 76.6 % of patients achieving an mRS of 0-2 (p = 0.32). Complications were reported in 4.2 % of cases, occurring in the liquid group (4.8 %) vs coiling group(3.2 %), with no significant difference in retreatment rates (7.4 %, p = 0.92). Procedural time was slightly longer in the coiling group (34.3 ± 8.6 min) compared to the liquid group (32.4 ± 17.3 min), though the difference lacked clinical significance. 87.7 % of patients showed improvement in mRS from admission to last follow-up in the overall cohort.
Conclusion:
MMA embolization with either proximal coiling or liquid agents is a safe and effective treatment for cSDH. Both approaches demonstrate comparable clinical outcomes and procedure times. Proximal coiling may be a viable alternative in cases where liquid agents or DMSO-compatible catheters are unavailable.
