Huanwen Chen, Matthew K McIntyre, Dhairya A Lakhani, Ajay Malhotra, Peter Kan, Dheeraj Gandhi, Marco Colasurdo
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引用次数: 0
Abstract
Background: Middle meningeal artery embolization (MMAE) is a promising treatment for non-acute subdural hematoma (NASDH), but trial evidence is limited by heterogeneity and open label design bias. This study aims to assess the real world effectiveness of MMAE as an adjunct to surgery and to explore sources of treatment effect heterogeneity.
Methods: This was a retrospective cohort study of the Nationwide Readmissions Database (2016-22). Adults who underwent NASDH surgery were included and divided into two groups: surgery with MMAE and surgery only groups. Propensity score matching (PSM) balanced patient characteristics. The primary outcome was treatment failure (subdural hematoma readmission, repeat surgery, or death). The secondary outcome was surgical rescue. Cox proportional hazards models compared outcomes within 180 days. Interaction testing identified sources of treatment effect heterogeneity.
Results: Of 31 444 included NASDH patients, 1544 underwent surgery with MMAE. After PSM, 1511 patients had surgery with MMAE and 4394 had surgery only. Surgery with MMAE was not associated with different rates of treatment failure (HR 0.80; 95% CI 0.56 to 1.13; P=0.20) or surgical rescue (HR 0.67; 95% CI 0.41 to 1.07; P=0.09). Interaction analyses revealed that surgical modality significantly modulated MMAE's association risk of treatment failure (P interaction <0.001). Among patients treated with percutaneous drainage (Burr hole or twist drill trephination), surgery with MMAE was associated with a significantly lower risk of treatment failure (HR 0.42; 95% CI 0.25 to 0.71; P=0.001) and surgical rescue (HR 0.50; 95% CI 0.27 to 0.91; P=0.023). Surgery with MMAE was not associated with treatment benefit among patients who underwent open evacuation.
Discussion: For NASDH patients requiring surgery, MMAE was significantly associated with superior outcomes as an adjunct to percutaneous drainage, but not as an adjunct to open evacuation.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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