Noninferiority of coiling versus coiling with particles in middle meningeal artery embolization: A technical note and case series.

Objective: To investigate the possibility of using coils as a standalone treatment for middle meningeal artery embolization.

Methods: Four patients (3 females, 1 male, median age 77.5) with bilateral subdural hematomas were treated with bilateral MMA embolization. One hematoma of each patient was treated with coils and PVA, and the other was treated exclusively with coils. New or resolved symptoms, radiographic imaging demonstrating hematoma change, and complications were recorded and compared between the two treatment modalities. Minimum follow-up time was three months.

Results: All patients demonstrated symptomatic and radiographic improvement at three month follow-up. None of the patients in this cohort received surgical evacuation of the hematoma prior to or after embolization. One patient had previously been treated for hydrocephalus with a VP shunt. There were no postoperative complications. In the hematomas treated with a combination of coils and particles, three showed complete resolution with one showing interval improvement on imaging. All hematomas treated with coils alone demonstrated complete resolution after three months.

Conclusions: Middle meningeal artery embolization with coils alone has demonstrated noninferior results to embolization with a combination of particle embolisate and coils in this small cohort.