International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population.

IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Avi A Gajjar, Mohamed M Salem, Georgios S Sioutas, Rashad Jabarkheel, Okkes Kuybu, Jane Khalife, Daniel A Tonetti, Gustavo Cortez, Adam A Dmytriw, Diego Alejandro Ortega Moreno, William Smith, Robert W Regenhardt, Kate T Carroll, Zachary A Abecassis, Juan Francisco Ruiz Rodriguez, Oleg Shekhtman, Alex Nguyen Hoang, Alexander A Khalessi, Cordell Baker, Matthias Matejka, Nicole M Cancelliere, Christoph J Griessenauer, Ramesh Grandhi, Peter Kan, Omar Tanweer, Michael R Levitt, Christopher J Stapleton, Vitor Mendes Pereira, Brian Jankowitz, Howard A Riina, Aman B Patel, Ricardo Hanel, Ajith J Thomas, Michael J Lang, Bradley A Gross, Jan-Karl Burkhardt, Visish M Srinivasan
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引用次数: 0

Abstract

BackgroundMiddle meningeal artery embolization (MMAE) is a promising treatment for chronic subdural hematoma (cSDH). Cancer patients are at risk for cSDH due to thrombocytopenia. The efficacy of MMAE in this population has not been studied.MethodsWe conducted a retrospective analysis of 76 patients who underwent 94 MMAEs for cSDH at 12 tertiary centers across North America and Europe between February 2018 and January 2023. We analyzed patient demographics, clinical profiles, procedural details, and outcomes. The primary outcome was cSDH progression, while secondary outcomes included radiographic resolution, mortality, 90-day functional outcomes, functional improvement, and procedural complications.ResultsRadiographic improvement occurred in 88.5% of patients, and technical success was achieved in 96.8%, with comparable rates between the MMAE-only and MMAE + surgery groups. Complications occurred in five patients (5.3%), with no significant difference between groups (6.0% in MMAE vs. 3.7% in MMAE + surgery, p = 0.658). Hemorrhage was reported in four patients (4.3%), and no cases of stroke were recorded. Mortality was 24.5% overall, with a slightly higher rate in the MMAE + surgery group (29.6%) compared to the MMAE-only group (22.4%, p = 0.460). Functional improvement in modified Rankin Scale (mRS) was seen in 15 patients (24.2%), with a significantly greater improvement in the combined group (Δ mRS = 2.625) versus the MMAE-only group (Δ mRS = 0.348, p < 0.001).ConclusionsMMAE is a safe and effective treatment option for managing cSDH in cancer patients. Higher mortality in this population is likely reflective of underlying cancer and comorbidities.

国际多中心研究:脑膜中动脉栓塞治疗癌症患者慢性硬膜下血肿:在高危人群中的疗效、安全性和结局。
背景:脑膜中动脉栓塞(MMAE)是治疗慢性硬膜下血肿(cSDH)的一种很有前景的治疗方法。由于血小板减少,癌症患者有罹患cSDH的风险。MMAE在这一人群中的疗效尚未得到研究。方法回顾性分析了2018年2月至2023年1月在北美和欧洲的12个三级中心接受94次MMAEs治疗cSDH的76例患者。我们分析了患者人口统计、临床概况、手术细节和结果。主要结局是cSDH进展,次要结局包括影像学缓解、死亡率、90天功能结局、功能改善和手术并发症。结果88.5%的患者放射学改善,96.8%的患者技术成功,仅MMAE和MMAE +手术组的比率相当。5例患者出现并发症(5.3%),两组间无显著差异(MMAE组为6.0%,MMAE +手术组为3.7%,p = 0.658)。4例患者报告出血(4.3%),无脑卒中病例记录。总体死亡率为24.5%,MMAE +手术组的死亡率(29.6%)略高于仅MMAE组(22.4%,p = 0.460)。改良Rankin量表(mRS)功能改善15例患者(24.2%),联合组(Δ mRS = 2.625)明显高于单纯mmae组(Δ mRS = 0.348, p
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来源期刊
Interventional Neuroradiology
Interventional Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
3.60
自引率
11.80%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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