Influence of procedural factors associated with injection of liquid embolics on outcomes after middle meningeal artery embolization for chronic subdural hematoma

Abstract

Background

Middle meningeal artery embolization (MMAe) is an effective treatment for chronic subdural hematoma. There are various procedural aspects related to liquid embolic (LE) injection that could influence radiographic resolution rates but require further study.

Methods

A retrospective review of consecutive MMAe procedures using LEs performed at a single institution was performed. Technical factors investigated included type of LE, microcatheter position during embolization, number of branches embolized, and depth of penetration. Outcomes included rescue treatment within 90 days, complete hematoma and midline shift (MLS) resolution, and modified Rankin Scale (mRS) 0–2 at 90 days.

Results

A total of 122 MMA embolizations performed on 95 patients (mean age 70.3 years, 66% male) were included. Hematoma recurrence requiring rescue treatment occurred for 12 hematomas (9.8%) among 10 patients. None of the technical factors were associated with rescue treatment, early MLS resolution, final hematoma resolution, final MLS resolution, or 90-day mRS 0–2. Contralateral penetration of embolisate was associated with increased odds of complete hematoma resolution (OR 8.4, 95% CI 1.79–50.38; p = 0.011) at early follow-up (median 2 months). The mean (± SD) hematoma reduction at early follow-up for contralateral penetration was 76.8% (37.2) compared to 56.5% (36) for only ipsilateral penetration (p = 0.047).

Conclusion

Contralateral penetration of LE may be associated with faster complete hematoma resolution but not the final radiographic result. These results require validation in larger cohorts.