Efficacy and Safety of Middle Meningeal Artery Embolization for Patients with Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2024-12-16 DOI:10.1159/000543041

Nabihah Kabir, Busmah Owais, Gabriela Trifan, Fernando Testai

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引用次数: 0

Abstract

Introduction: Chronic subdural hematoma (CSDH) is characterized by the collection of blood beneath the dura mater. Traditional treatments involve surgical drainage of the hematoma, but recurrence rates can be high. A highly vascularized neo-membrane irrigated by the middle meningeal artery (MMA) may be involved in CSDH re-accumulation. We conducted a systematic review and meta-analysis of studies that compared the efficacy and safety of MMA embolization to conventional treatment alone for CSDH.

Methods: A systematic search of PubMed, Embase Ovid, and ClinicalTrials.gov identified observational and randomized clinical studies comparing MMA embolization to conventional treatment for CSDH. The efficacy outcomes were hematoma recurrence and good functional outcome (as defined by a modified Rankin Scale Score [mRS] of 0-2). Safety outcomes were the rate of major complication and mortality. Heterogeneity among studies were evaluated using the I2 statistic. Analyses were conducted using Cochrane Review Manager Software, with risk ratios (RRs) and 95% confidence intervals (95% CI) presented for key outcomes. Absolute risk reduction (95% CI) of 1,000 patients was also calculated using GRADEpro software.

Results: The analysis included data from 13 studies (4 randomized clinical trials [RCTs] and 9 observational studies) with a total number of 2,960 patients (35.3% in the MMA group and 64.7% in the conventional treatment group). Compared to conventional treatment, MMA embolization decreased risk of hematoma recurrence by 59% (13 studies, RR = 0.41, 95% CI: 0.26-0.65; I2 = 49%), for an absolute effect of 116 fewer events/1,000 patients (95% CI: 69-145), with similar risk of major complications (13 studies, RR = 0.88, 95% CI: 0.67-1.15; I2 = 43%) and mortality risk (13 studies, RR = 1.05, 95% CI: 0.67-1.65). In subgroup analyses by study type, pooled results from RCTs showed similar direction effects as those from observational studies for both efficacy and safety outcomes.

Conclusion: MMA embolization in CSDH management is a safe and effective approach for CSDH.

查看原文本刊更多论文

脑膜中动脉栓塞术治疗慢性硬膜下血肿患者的有效性和安全性：系统回顾和 Meta 分析。

慢性硬膜下血肿（CSDH）以硬脑膜下积血为特征。传统的治疗方法包括手术引流血肿，但复发率可能很高。由脑膜中动脉（MMA）灌注的高度血管化的新膜可能参与了CSDH的再积累。我们进行了一项系统回顾和荟萃分析，比较了MMA栓塞治疗CSDH与常规治疗的疗效和安全性。方法：系统检索PubMed， Embase Ovid和ClinicalTrials.gov，确定观察性和随机临床研究，比较MMA栓塞与常规治疗慢性硬膜下血肿。疗效结果为血肿复发和良好的功能结果（根据修改的Rankin量表评分（mRS） 0-2定义）。安全性指标为主要并发症发生率和死亡率。采用I2统计量评估研究间的异质性。使用Cochrane Review Manager软件进行分析，给出了关键结果的风险比（RR）和95%置信区间（95% CI）。绝对风险降低（ARR, 95% CI） 1000例患者也使用GRADEpro软件计算。结果：纳入13项研究（4项rct和9项观察性研究）数据，共2960例患者（MMA组为35.3%，常规治疗组为64.7%）。与常规治疗相比，MMA栓塞使血肿复发风险降低59%(13项研究，RR=0.41, 95% CI 0.26-0.65；I2=49%)，绝对效果为116例事件/1000例患者减少（95% CI 69-145），主要并发症风险相似(13项研究，RR=0.88, 95% CI=0.67-1.15；I2 = 43%)和死亡风险（13项研究，RR=1.05, 95% CI=0.67-1.65）。在按研究类型进行的亚组分析中，随机对照试验的汇总结果显示，在疗效和安全性结果方面，方向效应与观察性研究的结果相似。结论：MMA栓塞治疗CSDH是一种安全有效的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.