Radiographic and clinical outcomes with particle or liquid embolic agents for middle meningeal artery embolization of nonacute subdural hematomas

Jonathan P. Scoville, Evan Joyce, Daniel A. Tonetti, Michael T. Bounajem, Ajith Thomas, Christopher S. Ogilvy, Justin M. Moore, Howard A. Riina, Omar Tanweer, Elad I. Levy, Alejandro M. Spiotta, Bradley A. Gross, Brian T. Jankowitz, C. Michael Cawley, Alexander A. Khalessi, Aditya S. Pandey, Andrew J. Ringer, Ricardo Hanel, Rafael A. Ortiz, David LangerMichael R. Levitt, Mandy Binning, Philipp Taussky, Peter Kan, Ramesh Grandhi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Middle meningeal artery (MMA) embolization is an apparently efficacious minimally invasive treatment for nonacute subdural hematomas (NASHs), but how different embolisates affect outcomes remains unclear. Our objective was to compare radiographic and clinical outcomes after particle or liquid MMA embolization. Methods: Patients who had MMA embolization for NASH were retrospectively identified from a multi-institution database. The primary radiographic and clinical outcomes—50% NASH thickness reduction and need for surgical retreatment within 90 days, respectively—were compared for liquid and particle embolizations in patients treated 1) without surgical intervention (upfront), 2) after recurrence, or 3) with concomitant surgery (prophylactic). Results: The upfront, recurrent, and prophylactic subgroups included 133, 59, and 16 patients, respectively. The primary radiographic outcome was observed in 61.8%, 61%, and 72.7% of particle-embolized patients and 61.3%, 55.6%, and 20% of liquid-embolized patients, respectively (p = 0.457, 0.819, 0.755). Hazard ratios comparing time to reach radiographic outcome in the particle and liquid groups or upfront, recurrent, andprophylactic timing were 1.31 (95% CI 0.78–2.18; p = 0.310), 1.09 (95% CI 0.52–2.27; p = 0.822), and 1.5 (95% CI 0.14–16.54; p = 0.74), respectively. The primary clinical outcome occurred in 8.0%, 2.4%, and 0% of patients who underwent particle embolization in the upfront, recurrent, and prophylactic groups, respectively, compared with 0%, 5.6%, and 0% who underwent liquid embolization (p = 0.197, 0.521, 1.00). Conclusions: MMA embolization with particle and liquid embolisates appears to be equally effective in treatment of NASHs as determined by the percentage who reach, and the time to reach, 50% NASH thickness reduction and the incidence of surgical reintervention within 90 days.

Original languageEnglish (US)
Pages (from-to)683-690
Number of pages8
JournalInterventional Neuroradiology
Volume29
Issue number6
DOIs
StatePublished - Dec 2023
Externally publishedYes

Keywords

  • Chronic subdural hematoma
  • liquid embolization
  • middle meningeal artery embolization
  • nonacute subdural hematoma
  • particle embolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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