Santiago Gomez-Paz, Mohamed M Salem, Cordell Baker, Okkes Kuybu, Georgios S Sioutas, Kate T Carroll, Mira Salih, Adam A Dmytriw, Jane Khalife, William Smith, Diego Alejandro Ortega Moreno, Robert W Regenhardt, Nicole M Cancelliere, Alejandro M Spiotta, Omar Tanweer, Christopher J Stapleton, Michael Lang, Vitor M Pereira, Aman B Patel, Adnan H Siddiqui, Elad I Levy, Christopher S Ogilvy, Daniel Tonetti, Ajith J Thomas, Visish M Srinivasan, Brian T Jankowitz, Michael R Levitt, Bradley A Gross, Jan-Karl Burkhardt, Ramesh Grandhi
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Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, <i>p</i> = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43-3.51, <i>p</i> < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25-0.69, <i>p</i> = 0.001) to be independent at last follow-up.ConclusionThis study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251339536"},"PeriodicalIF":1.5000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075154/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.\",\"authors\":\"Santiago Gomez-Paz, Mohamed M Salem, Cordell Baker, Okkes Kuybu, Georgios S Sioutas, Kate T Carroll, Mira Salih, Adam A Dmytriw, Jane Khalife, William Smith, Diego Alejandro Ortega Moreno, Robert W Regenhardt, Nicole M Cancelliere, Alejandro M Spiotta, Omar Tanweer, Christopher J Stapleton, Michael Lang, Vitor M Pereira, Aman B Patel, Adnan H Siddiqui, Elad I Levy, Christopher S Ogilvy, Daniel Tonetti, Ajith J Thomas, Visish M Srinivasan, Brian T Jankowitz, Michael R Levitt, Bradley A Gross, Jan-Karl Burkhardt, Ramesh Grandhi\",\"doi\":\"10.1177/15910199251339536\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, <i>p</i> = 0.034). 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引用次数: 0
摘要
研究背景：我们研究了脑膜中动脉栓塞（MMAE）治疗慢性硬膜下血肿（CSDH）患者的放射学和临床结果的种族差异。方法本多中心回顾性研究包括北美11家机构（美国10家，加拿大1家）连续接受MMAE的患者。使用自我报告的种族数据对患者进行分层。最后随访的结果是并发症、治疗失败/再手术、血肿消退和功能独立。多变量回归模型用于评估和调整相关混杂因素。结果共557例患者接受了663例MMAEs，其中白人323例（58%），黑人150例（27%），西班牙裔35例（6%），亚洲29例（5%），20例（4%）自我分类为其他/未披露。队列的中位年龄（四分位数范围）为75岁（65-81），412例（74%）患者为女性。脑膜中动脉栓塞是369例（66%）CSDH患者的主要治疗方法，188例（34%）辅助治疗。黑人患者再手术的可能性比其他种族低51%(校正优势比[OR] 0.49；95%置信区间[CI] 0.25 ~ 0.95, p = 0.034)。白人患者的可能性是白人患者的两倍(差异为11%；调整OR 2.24；95% CI 1.43-3.51, p p = 0.001)为独立随访。结论：本研究强调了CSDH MMAE术后结果的显著种族差异，无论是否进行疏散手术。白人患者的再手术率较高，但在最后随访时功能独立的可能性更大。黑人患者，尽管基线功能状态较好，但术后功能独立的几率较低。
Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.
BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, p = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43-3.51, p < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25-0.69, p = 0.001) to be independent at last follow-up.ConclusionThis study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.
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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