Garrett W Thrash, Bluyé DeMessie, Elijah L Wang, Jesse G Jones, Muhammed Amir Essibayi, Hamza Adel Salim, Alireza Karandish, Deepak Khatri, Neil Haranhalli, Amanda Baker, Richard Zampolin, Allan L Brook, Seon-Kyu Lee, Nimer Adeeb, Dhairya A Lakhani, Yan-Lin Li, Davide Simonato, Diego Alejandro Ortega, Nicole Cancelliere, Jose Danilo Diestro, Joseph Carnevale, Craig Schreiber, Atakan Orscelik, Zachary Abecassis, Spencer Raub, Georgios S Sioutas, Abdulrhman Alsalama, Clairice Pearce, Giancarlo Salsano, Rahim Abo Kasem, Svetlana Kvint, Andrew Falzon, Vance Cantrell, Brian Holliday, Jefferson O Abaricia, Pedram D Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Jorge Rios Zermeno, Prateeka Koul, Ahmed Aljuboori, Dominik F Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, James Grist, Fulvio Zaccagna, Christopher S Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A Möhlenbruch, Luca Scarcia, William W Wroe, Hussein A Zeineddine, Si Zhao Tang, Peter B Sporns, Anil Gopinathan, Robert W Regenhardt, Spiros L Blackburn, Clemens M Schirmer, Thien Huynh, Rabih G Tawk, Fabio Settecase, Stavropoula Tjoumakaris, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Marco Colasurdo, Hussein H Nasser, Sri Hari Sundararajan, Pascal J Mosimann, Erez Nossek, Eytan Raz, Sami Al Kasab, Alejandro M Spiotta, Lucio Castellan, Bruno Del Sette, Ali Alaraj, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M Srinivasan, Jan-Karl Burkhardt, Gaultier Marnat, Pietro Mario Santini, Michael R Levitt, Giuseppe Lanzino, Waleed Brinjikji, Jared Knopman, Tareq Kass-Hout, Julian Spears, Thomas Marotta, Vitor Mendes Pereira, Maurizio Fuschi, Tufail Patankar, David J Altschul, Adam A Dmytriw
{"title":"Multi-pedicle versus single-pedicle middle meningeal artery embolization for nonacute subdural hematoma.","authors":"Garrett W Thrash, Bluyé DeMessie, Elijah L Wang, Jesse G Jones, Muhammed Amir Essibayi, Hamza Adel Salim, Alireza Karandish, Deepak Khatri, Neil Haranhalli, Amanda Baker, Richard Zampolin, Allan L Brook, Seon-Kyu Lee, Nimer Adeeb, Dhairya A Lakhani, Yan-Lin Li, Davide Simonato, Diego Alejandro Ortega, Nicole Cancelliere, Jose Danilo Diestro, Joseph Carnevale, Craig Schreiber, Atakan Orscelik, Zachary Abecassis, Spencer Raub, Georgios S Sioutas, Abdulrhman Alsalama, Clairice Pearce, Giancarlo Salsano, Rahim Abo Kasem, Svetlana Kvint, Andrew Falzon, Vance Cantrell, Brian Holliday, Jefferson O Abaricia, Pedram D Maleknia, Leonardo Cruz-Criollo, Samantha Schimmel, Basel Musmar, Matthew Alexander, Jorge Rios Zermeno, Prateeka Koul, Ahmed Aljuboori, Dominik F Vollherbst, Domagoj Gajski, Jared Cooper, Omar Alwakaa, Mohamad Ezzeldin, James Grist, Fulvio Zaccagna, Christopher S Ogilvy, Fawaz Al-Mufti, Vladimir Kalousek, Markus A Möhlenbruch, Luca Scarcia, William W Wroe, Hussein A Zeineddine, Si Zhao Tang, Peter B Sporns, Anil Gopinathan, Robert W Regenhardt, Spiros L Blackburn, Clemens M Schirmer, Thien Huynh, Rabih G Tawk, Fabio Settecase, Stavropoula Tjoumakaris, Pascal Jabbour, Kunal Vakharia, Mario Zanaty, Santiago Ortega-Gutierrez, Marco Colasurdo, Hussein H Nasser, Sri Hari Sundararajan, Pascal J Mosimann, Erez Nossek, Eytan Raz, Sami Al Kasab, Alejandro M Spiotta, Lucio Castellan, Bruno Del Sette, Ali Alaraj, Caterina Michelozzi, Davide Saraceno, Pietro Panni, Visish M Srinivasan, Jan-Karl Burkhardt, Gaultier Marnat, Pietro Mario Santini, Michael R Levitt, Giuseppe Lanzino, Waleed Brinjikji, Jared Knopman, Tareq Kass-Hout, Julian Spears, Thomas Marotta, Vitor Mendes Pereira, Maurizio Fuschi, Tufail Patankar, David J Altschul, Adam A Dmytriw","doi":"10.1007/s00234-026-04187-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Nonacute subdural hematomas (nSDH) are common yet serious extra-axial hemorrhages that result in significant morbidity and mortality. Middle meningeal artery (MMA) embolization (MMAE) is a recent endovascular treatment that involves occlusion of the MMA, inducing hemostasis in and around the hematoma. While many aspects of MMAE have been explored, there is currently limited data on the optimal extent of embolization.</p><p><strong>Objective: </strong>To determine whether single or multiple pedicle embolization of the MMA is superior in inducing hemostasis in nSDH.</p><p><strong>Methods: </strong>We compared single versus multi pedicle embolization by a retrospective multicenter analysis of nSDH patients who underwent MMAE between 2019 and 2024 at participating centers in the MESH (MMA Embolization for Subdural Hematoma) Registry. 679 patients who received a liquid embolic agent with branch-level embolization data were included.</p><p><strong>Results: </strong>While multi-pedicle embolization hastened nSDH thinning at 1 month (5.7 vs. 3.3 mm reduction; difference 2.4 mm, 95% CI 1.0-3.8; P = .002), by 3 months thickness reduction had converged between groups (8.2 vs. 8.4 mm; P = .91). Among 679 patients (456 multi-pedicle, 223 single-pedicle), favorable functional outcome (mRS 0-2) was more frequent with multi-pedicle embolization (53.5% vs. 43.0%; adjusted OR 1.81, 95% CI 1.26-2.60; P = .001), whereas recurrence, rescue surgery, and treatment failure did not differ.</p><p><strong>Conclusion: </strong>Future, multi-center randomized prospective trials are warranted to address confounding variables that limit this observational study. Follow-up beyond 3 months was limited, so durability is unknown.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00234-026-04187-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Nonacute subdural hematomas (nSDH) are common yet serious extra-axial hemorrhages that result in significant morbidity and mortality. Middle meningeal artery (MMA) embolization (MMAE) is a recent endovascular treatment that involves occlusion of the MMA, inducing hemostasis in and around the hematoma. While many aspects of MMAE have been explored, there is currently limited data on the optimal extent of embolization.
Objective: To determine whether single or multiple pedicle embolization of the MMA is superior in inducing hemostasis in nSDH.
Methods: We compared single versus multi pedicle embolization by a retrospective multicenter analysis of nSDH patients who underwent MMAE between 2019 and 2024 at participating centers in the MESH (MMA Embolization for Subdural Hematoma) Registry. 679 patients who received a liquid embolic agent with branch-level embolization data were included.
Results: While multi-pedicle embolization hastened nSDH thinning at 1 month (5.7 vs. 3.3 mm reduction; difference 2.4 mm, 95% CI 1.0-3.8; P = .002), by 3 months thickness reduction had converged between groups (8.2 vs. 8.4 mm; P = .91). Among 679 patients (456 multi-pedicle, 223 single-pedicle), favorable functional outcome (mRS 0-2) was more frequent with multi-pedicle embolization (53.5% vs. 43.0%; adjusted OR 1.81, 95% CI 1.26-2.60; P = .001), whereas recurrence, rescue surgery, and treatment failure did not differ.
Conclusion: Future, multi-center randomized prospective trials are warranted to address confounding variables that limit this observational study. Follow-up beyond 3 months was limited, so durability is unknown.
简介：非急性硬膜下血肿（nSDH）是一种常见但严重的轴外出血，可导致显著的发病率和死亡率。脑膜中动脉（MMA）栓塞（MMAE）是一种最近的血管内治疗方法，包括闭塞MMA，诱导血肿内部和周围的止血。虽然MMAE的许多方面已经被探索，但目前关于最佳栓塞程度的数据有限。目的：探讨MMA单蒂栓塞和多蒂栓塞对非sdh患者的止血效果。方法：我们通过对MESH （MMA栓塞治疗硬膜下血肿）注册中心参与的2019年至2024年期间接受MMAE治疗的nSDH患者进行回顾性多中心分析，比较单蒂栓塞和多蒂栓塞，其中包括679名接受液体栓塞剂并具有分支水平栓塞数据的患者。结果：虽然多蒂栓塞在1个月时加速了nSDH的减薄（5.7 vs 3.3 mm；差异2.4 mm, 95% CI 1.0-3.8; P = 0.002），但3个月时，两组之间的厚度减少趋同（8.2 vs 8.4 mm; P = 0.91）。在679例患者中（456例多椎弓根，223例单椎弓根），多椎弓根栓塞更常见的是良好的功能结果（mRS 0-2）（53.5%比43.0%；校正OR 1.81, 95% CI 1.26-2.60; P = .001），而复发、抢救手术和治疗失败没有差异。结论：未来有必要进行多中心随机前瞻性试验，以解决限制本观察性研究的混杂变量。随访时间有限，超过3个月，因此持续时间未知。
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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