Real-World Safety Profile of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: a Multinational Multicenter Study.
Publication/Presentation Date
6-11-2026
Abstract
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.
ISSN
1869-1447
Published In/Presented At
DeMessie, B., Karandish, A., Essibayi, M. A., Salim, H. A., Khatri, D., Haranhalli, N., Baker, A., Zampolin, R., Brook, A. L., Lee, S. K., Adeeb, N., Lakhani, D. A., Li, Y. L., Ortega, D. A., Cancelliere, N., Diestro, J. D., Carnevale, J., Schreiber, C., Orscelik, A., Abecassis, Z., … Altschul, D. J. (2026). Real-World Safety Profile of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: a Multinational Multicenter Study. Clinical neuroradiology, 10.1007/s00062-026-01686-w. Advance online publication. https://doi.org/10.1007/s00062-026-01686-w
Disciplines
Medicine and Health Sciences
PubMedID
42274749
Department(s)
Fellows and Residents
Document Type
Article