Comparison of clinical and radiological outcomes using solely particles versus particles with coils in middle meningeal artery embolization for chronic subdural hematoma: a longitudinal comparative cohort study.

Abstract

Objective: Chronic subdural hematoma (cSDH) recurrence is a significant cause of morbidity in neurosurgical patients. Middle meningeal artery embolization (MMAe) effectively reduces cSDH recurrence by targeting its associated inflammatory cascade. Delayed recanalization can occur from proximal branches of the middle meningeal artery (MMA) after use of particle embolic agents. Surgeons may utilize coil embolization in addition to particle embolic agents to achieve proximal vessel control. This study compares reaccumulation rates for cSDH patients undergoing particle embolization of the MMA with and without coil embolization.

Methods: A retrospective review of prospectively collected data was performed on the records of patients who underwent particle MMAe with or without coils for cSDH at the authors' institution from 2021 to 2023 The primary outcome was cSDH recurrence at CT follow-up at least 1 month after MMAe.

Results: Sixty-two patients underwent 81 embolization procedures with particles alone (n = 32) or particles and coils (n = 49). There was no significant difference in recurrence between particles versus particles and coils (6.3% vs 10.2%, p = 0.698). There was a statistical difference in procedure length (54.8 ± 28.7 vs 85.9 ± 26.5 minutes, p < 0.001) and fluoroscopy time (34.9 ± 20.8 vs 48.8 ± 24.7 minutes, p = 0.01) between patients who underwent particle embolization versus those who underwent embolization with particles and coils. A noninferiority analysis demonstrated no significant difference between groups in treatment failure, hematoma expansion, and follow-up size > 1 cm.

Conclusions: In the setting of cSDH, MMAe using particles only versus particles with coils shows similar rates of hematoma reaccumulation and resolution. Procedural time and fluoroscopy time were significantly reduced within the particle embolization-alone cohort. When comparing hematoma resolution and expansion, follow-up hematoma size > 1 cm, and decrease in hematoma size > 1 cm between groups, embolization using particles alone was not inferior to embolization using particles supplemented with coils.