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

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.

Déclaration de conflit d'intérêts

Declaration of conflicting interestsHoward Riina is a consultant for Medtronic. Elad Levy has shares/ownership interest in NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and Three Rivers Medical; has a patent for Bone Scalpel; receives honoraria for training and lectures from Medtronic, Penumbra, MicroVention, and Integra; is a consultant for Clarion, IRRAS AB, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, and Mosiac; is the Chief Medical Officer of Haniva Technology; is a national principal investigator for Medtronic; is on the steering committees of SWIFT Prime and SWIFT Direct trials; is the site PI for the CONFIDENCE study (MicroVention) and sub-PI for the STRATIS study (Medtronic); serves on the advisory board for Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, and IRRAS AB; and provides medical/legal opinions for medical legal review; and has leadership or fiduciary roles in CNS, ABNS, and UBNS. Alejandro Spiotta has research support from Penumbra, Stryker, Medtronic, and RapidAI and is a consultant for Penumbra, Stryker, Terumo, and RapidAI. Bradley Gross is a consultant for Medtronic and Medvision. Adita Pandey has stock in NextGen Biologics and FlexDex Surgical. Ricardo Hanel is a consultant for Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical, and Q'Apel; he is on advisory board for MiVI, eLum, Three Rivers, Shape Medical and Corindus; he has received unrestricted research grants from NIH, Interline Endowment, Microvention, Stryker, CNX; he is an investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. David Langer is a consultant of ORBEYE. Michael Levitt has grants from the National Institutes of Health, The Aneurysm and AVM Foundation, Congress of Neurological Surgeons Society of NeuroInterventional Surgery, is a consultant for Medtronic, has investigator-initiated unrestricted educational grants from Medtronic and Styker, is a shareholder of Proprio, Cerebrotech, Synchron, Hyperion Surgical, has equity interest in Fluid Biomed and Stereotaxis, is an advisor for Aeaean Advisers, and is on the Journal of NeuroInterventional Surgery editorial board. Philipp Taussky is a consultant for Avail Medsystems, Johnson & Johnson, Medtronic, and Stryker Neurovascular. Peter Kan is a consultant for Stryker Neurovascular, MicroVention, and Imperative Care. Ramesh Grandhi is a consultant for Balt Neurovascular, Cerenovus, Integra, and Medtronic Neurovascular.