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Predicting subdural hematoma outcomes as a function of PACE score.

Ryan W Sindewald1, Brian R Hirshman1, Nicholas S Hernandez1

  • 1Department of Neurosurgery, UC San Diego School of Medicine, CA, USA.

Journal of Cerebrovascular and Endovascular Neurosurgery
|January 20, 2026
PubMed
Summary

The Patency after Coil Embolization (PACE) score effectively predicts subdural hematoma resolution. A higher PACE score indicates a greater likelihood of significant hematoma reduction after embolization treatment.

Keywords:
EmbolizationEndovascular proceduresFluoroscopyHematomaSubdural

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Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Subdural hematomas (SDHs) pose significant clinical challenges.
  • Middle meningeal artery (MMA) embolization is an emerging treatment for SDHs.
  • Predictive markers for treatment success are needed.

Purpose of the Study:

  • To evaluate the relationship between the Patency after Coil Embolization (PACE) score and SDH resolution.
  • To determine if the PACE score can predict successful hematoma reduction after MMA embolization.

Main Methods:

  • Retrospective analysis of 43 patients with SDH treated with MMA coil embolization.
  • Measurement of hematoma cross-sectional area (CSA) on pre- and post-operative CT scans.
  • Use of ROC curve analysis to establish a resolution threshold and logistic regression to identify predictors of resolution.

Main Results:

  • A hematoma resolution of 70.9% was identified as the optimal threshold.
  • The PACE score was the sole statistically significant predictor of achieving at least 70.9% hematoma resolution in multivariate analysis.
  • Follow-up time and initial hematoma size showed univariate significance.

Conclusions:

  • The PACE score is a highly significant predictor of successful subdural hematoma resolution following coil embolization.
  • This score can aid in assessing treatment outcomes and patient prognosis.