Real-World Safety Profile of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: a Multinational Multicenter Study.
DeMessie B., Karandish A., Essibayi MA., Salim HA., Khatri D., Haranhalli N., Baker A., Zampolin R., Brook AL., Lee S-K., Adeeb N., Lakhani DA., Li Y-L., Ortega DA., Cancelliere N., Diestro JD., Carnevale J., Schreiber C., Orscelik A., Abecassis Z., Raub S., Sioutas GS., Alsalama A., Pearce C., Salsano G., Abo Kasem R., Kvint S., Falzon A., Cantrell V., Holliday B., Abaricia JO., Maleknia P., Cruz-Criollo L., Schimmel S., Musmar B., Alexander M., Zermeno JR., Prateeka K., Aljuboori A., Vollherbst DF., Gajski D., Cooper J., Alwakaa O., Ezzeldin M., Grist J., Zaccagna F., Ogilvy CS., Al-Mufti F., Kalousek V., Möhlenbruch MA., Scarcia L., Wroe WW., Zeineddine HA., Si Zhao T., Sporns PB., Gopinathan A., Regenhardt RW., Blackburn SL., Schirmer CM., Huynh T., Tawk R., Settecase F., Tjoumakaris S., Jabbour P., Vakharia K., Zanaty M., Ortega-Gutierrez S., Jones JG., Colasurdo M., Nasser HH., Sundararajan SH., Mosimann PJ., Nossek E., Raz E., Al Kasab S., Spiotta AM., Castellan L., Del Sette B., Alaraj A., Michelozzi C., Saraceno D., Panni P., Srinivasan VM., Burkhardt J-K., Marnat G., Santini PM., Levitt MR., Lanzino G., Knopman J., Kass-Hout T., Spears J., Marotta T., Mendes Pereira V., Patankar T., Dmytriw AA., Altschul DJ.
BACKGROUND: Middle meningeal artery embolization (MMAE) has emerged as a treatment for chronic subdural hematoma (cSDH), but comprehensive real-world safety data remain limited. METHODS: We performed a multicenter retrospective analysis of 1781 consecutive patients undergoing MMAE for cSDH (2019-2025). The primary outcome was any procedure-related complication within 30 days. Inverse probability of treatment weighting (IPTW) assessed the association between technical success and complications, adjusting for demographic, clinical, and procedural confounders. RESULTS: Mean age was 72.8 ± 12.4 years; 68.1% were male. The 30-day complication rate was 5.1% (91/1781; 95% CI, 4.1-6.2). In-hospital mortality was 2.9% (47/1625). Technical success was achieved in 97.5% (1505/1543). Among documented complications, thromboembolic events were most common (37.2%; 32/86), followed by hemorrhagic complications (23.8%; 20/84) and access-site hematoma (10.4%; 8/77). Among patients with classifiable symptom status, 80.6% of complications were symptomatic, yielding an overall symptomatic complication rate of 3.0%. Neurological deterioration occurred in 27.1% (248/915). Among 1552 patients with documented surgical approach, complication rates were similar between surgery plus embolization (4.9%; 34/690) and embolization alone (5.2%; 45/860; OR, 0.94; 95% CI, 0.59-1.48; p = 0.79). After IPTW adjustment, technical success was associated with an 86% reduction in complication odds (OR, 0.14; 95% CI, 0.05-0.40; p < 0.001). CONCLUSIONS: In this large multicenter cohort, MMAE was associated with a 5.1% complication rate. Technical success was the strongest protective factor. Embolization with or without surgery showed equivalent safety profiles.