O-007 Long term outcomes in middle meningeal artery embolization for chronic subdural hematoma

Le résumé fourni par la source

Introduction Multiple recent randomized controlled trials have supported the use of middle meningeal artery embolization (MMAe) in the management of chronic subdural hematoma (cSDH). With rates of cSDH predicted to surpass the number of large vessel occlusion strokes in the near future, there is significant interest in understanding long-term post-embolization outcomes in this population, beyond the 90- or 180-day end points studied in clinical trials thus far. Methods Via retrospective chart review of all cSDH patients who underwent MMAe at a tertiary care center from January 2019 to December 2022, a total of 222 cSDH were identified from 196 unique patients. Patient demographic data (age, sex, history of trauma), characteristics of the cSDH (laterality, size, acuity), intervention details (any intervention prior to MMAe, embolization material), and long-term outcomes (cSDH size on follow-up CT Head, modified Rankin Scale [mRS], need for re-intervention, and mortality) were collected. Univariate analyses using the Chi-square test for categorical variables and the Wilcoxon rank sum test for continuous variables were performed. Generalized multivariable regression models were used to compare associations between delta cSDH size (size at 3 months minus size at 6 months; size at 3 months minus size at 12 months) to mortality and mRS. Results With an average age of 72.8 years (SE 0.94), the study population was predominantly male (75.7%) and had a slight preponderance for right-sided cSDH (54.5%). Average baseline cSDH size was 12.1mm (SE 1.1) and improved to 7.9mm (SE 1.1), 6.8mm (SE 1.4), 4.9mm (SE 1.3), and 1.8mm (SE 1.2) at 1-, 3-, 6-, and 12-month intervals, respectively. 15.6% of cSDH required re-intervention after MMAe, due to cSDH re-accumulation or persistent symptomatic mass effect, for which 9.4% of the total cohort underwent repeat embolization and 6.3% underwent craniectomy. Mortality at 6 months was 13.3%. There was no association between delta cSDH size at both 6- and 12-month time points with mRS or mortality. Conclusion We found a continued reduction in cSDH size that extends beyond the first 90 days and into the 6- and 12-month post-MMAe time points. This reduction is not correlated to changes in mRS or mortality, suggesting that medical comorbidities contribute significantly to long-term prognosis after MMAe for cSDH. Disclosures S. Polineni: None. J. Scaggiante: None. R. Haynes: None. H. Shoirah: None.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.