Standalone Middle Meningeal Artery Embolization Versus Conservative Management for Nontraumatic Subdural Hematoma.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-06-01 Epub Date: 2025-04-03 DOI:10.1161/STROKEAHA.124.050190

Huanwen Chen, Mihir Khunte, Marco Colasurdo, Ajay Malhotra, Dheeraj Gandhi

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引用次数: 0

Abstract

Background: Recent randomized control trials have demonstrated the efficacy and safety of middle meningeal artery embolization (MMAE) as an adjunct to conventional management for patients with nonacute subdural hematoma (SDH); however, a large majority of trial participants received surgical evacuation as part of the standard of care. Thus, the efficacy and safety of standalone MMAE compared with conservative management (CM) for patients with nonsurgical SDH are unclear.

Methods: This was a retrospective cohort study of the 2019 to 2021 Nationwide Readmissions Database in the United States. Patients with nonsurgical nontraumatic SDH were identified, and MMAE patients were matched with similar CM patients using propensity scores calculated from demographics, comorbidities, and initial hospitalization outcomes. Patients were followed up to 300 days. The primary end point was composite surgical rescue or death, and secondary end points included surgical rescue and all-cause mortality by 180 days.

Results: A total of 24 465 patients with nonsurgical nontraumatic SDH were identified; 2228 (9.1%) underwent MMAE. After propensity score matching, 6675 patients remained in the CM group and 2217 in the MMAE group. At 180 days, MMAE patients had a significantly lower risk of surgery or death compared with CM (8.2% versus 10.9%; relative risk, 0.75 [95% CI, 0.59-0.96]; P=0.022) and lower risk of death (1.1% versus 3.0%; relative risk, 0.38 [95% CI, 0.17-0.86]; P=0.020). Rates of surgical rescue among MMAE and CM patients at 180 days were similar (7.1% versus 8.4%; relative risk, 0.85 [95% CI, 0.63-1.14]; P=0.27). Time-to-event analyses for the entire 300-day study follow-up period confirmed that while MMAE was associated with a lower cumulative risk of all-cause mortality (hazard ratio, 0.55 [95% CI, 0.35-0.87]; P=0.010), it was not associated with a different risk of surgical rescue (hazard ratio, 1.00 [95% CI, 0.76-1.31]; P=1.00).

Conclusions: Standalone MMAE may be beneficial for patients with nonsurgical nontraumatic SDH by reducing the long-term risk of all-cause mortality.

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独立脑膜中动脉栓塞与保守治疗非外伤性硬膜下血肿。

背景：最近的随机对照试验已经证明了脑膜中动脉栓塞（MMAE）作为非急性硬膜下血肿（SDH）患者常规治疗的辅助治疗的有效性和安全性；然而，绝大多数试验参与者接受手术疏散作为标准护理的一部分。因此，与保守治疗（CM）相比，单用MMAE治疗非手术性SDH的疗效和安全性尚不清楚。方法：这是一项针对美国2019年至2021年全国再入院数据库的回顾性队列研究。确定非手术性非创伤性SDH患者，并使用从人口统计学、合并症和初始住院结果计算的倾向评分匹配将MMAE患者与相似的CM患者进行匹配。患者随访300天。主要终点是复合手术抢救或死亡，次要终点包括手术抢救和180天的全因死亡率。结果：共发现24465例非手术性非外伤性SDH；2228例（9.1%）行MMAE。倾向评分匹配后，CM组有6675例，MMAE组有2217例。在180天，与CM患者相比，MMAE患者的手术或死亡风险显著降低(8.2% vs 10.9%；相对危险度为0.75 [95% CI, 0.59-0.96]；P=0.022)和较低的死亡风险(1.1%对3.0%；相对危险度，0.38 [95% CI, 0.17-0.86]；P = 0.020)。MMAE和CM患者180天的手术抢救率相似(7.1% vs 8.4%；相对危险度为0.85 [95% CI, 0.63-1.14]；P = 0.27)。对整个300天研究随访期的事件时间分析证实，尽管MMAE与全因死亡累积风险较低相关(风险比0.55 [95% CI, 0.35-0.87]；P=0.010)，与手术抢救的不同风险无关(风险比1.00 [95% CI, 0.76-1.31]；P = 1.00)。结论：通过降低全因死亡率的长期风险，独立MMAE可能对非手术性非外伤性SDH患者有益。

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

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.