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Introduction/PurposeMiddle meningeal artery embolization (MMAe) can be performed as either a standalone treatment (Upfront) or in adjunct to surgical evacuation (Prophylactic within 2 weeks of surgical intervention or Salvage when >2 weeks of surgical intervention) to reduce nonacute subdural hematoma (NASDH) recurrence. Data from the EMBOLISE trial have established the efficacy of particle and liquid embolics in MMAe. These embolics confer the risk of non-target embolization ranging from vasa nervosum damage with cranial nerve palsy to ischemic stroke via external to internal carotid anastomoses.In 2023, Iyer-et-al evaluated the efficacy of long-coil-construct to spinosum MMAe in a 45 patient-cohort with 34 minutes mean fluoroscopy time. Our study further evaluates the efficacy of primary coil MMAe with shorter length coil-constructs. Null hypotheses include reduced fluoroscopy times, low failure rate, and collection size with density reduction over a 1–3 month period.Materials and MethodsRetrospective review of primary coil MMAe cases categorized as Upfront, Prophylactic, or Salvage was performed. Fluoroscopy time, MMA size via Spinosum Roentgen Index (S.R.I.), MMA angiographic diameter, coils utilized, pre-and-post MMAe head CT scans with collection size and Hounsfield unit density measurements, and patient outcomes were recorded.Results65 primary coil MMAe procedures (53 males, 18 females; mean 71 years, minimum 9 years, maximum 96 years) for NASDH management were identified. 29 unilateral MMAe and 36 bilateral MMAe were performed January 2022 to January 2025. 34 Upfront, 31 Prophylactic, and 6 Salvage MMAe procedures were performed with low fluoroscopy times (mean 5.8 minutes, minimum 1.6 minutes, maximum 15.8 minutes). Correlation of S.R.I. with MMA size (P<0.001) aided in 1–3 mm diameter coil selections. 63/65 cases resulted in statistically-significant reductions in NASDH size (p<0.05) and non-statistically significant reductions in NASDH density (p>0.05) despite MMAe subtype (figure 1A and 1B). One case requiring embolization of an accessory MMA given native MMA absence yielded similar-to-cohort reduction in NASDH size without cranial neuropathy. Two failures were attributed to incomplete MMA occlusion from initial coil pack (figure 1B right upper quadrant), one of whom returned for re-embolization.ConclusionCoil embolization is an effective well-tolerated treatment for NASDH resulting in significant reductions in collection size and trended decrease in density reduction over time, noting scar/dural thickening may yield higher density measurements. Pre-intervention imaging aides in sizing coil constructs while reducing radiation exposure. Short-coil-constructs straddling the frontoparietal and temporal divisions (Y configuration) or individually in divisions can be placed without worry of ECA-ICA anastomoses.Abstract E-147 Figure 1DisclosuresM. Afridi: None. A. Abramyan: None. A. Soliman: None. E. Nourollah-Zadeh: None. H. Sun: None. G. Gupta: None. S. Roychowdhury: None. S. Sundararajan: None.

Background/ObjectiveUnderstanding the prevalence and angioarchitecture of orbital branches of the middle meningeal artery (MMA), such as the meningolacrimal anastomosis (MLA), is critical to safely perform MMA embolizations. The diminutive size of these dural branches have limited the capacity to perform detailed dissection studies, and clinical angiographies likely underdiagnose the prevalence of these branches given the competing arterial flow from the orbit. We conducted a human cadaveric study to quantify the frequency and anatomical parameters of MLA by performing isolated high resolution angiography and DynaCTs of the MMA.MethodsAngiographies and Dyna CT were performed by navigating microcatheters and injecting iodinated contrast in the extracranial MMA in eight (8) human cadaveric specimens. Native and reconstructed images were analyzed for prevalence and morphometric variations.ResultsThe MLA was identified in 15 of 16(93.7%) specimens. Among these, 87.5% had a single ML branch per MMA, while 12.5% had more than one branch. The mean length of the dural segment of the MLA (from the origin at the MMA to the entry into the orbit) was 1.77 ± 0.70 cm. The mean diameter of the MLA was 0.93 ± 0.29 mm, and the MMA diameter at the origine of the MLA measured 2.15 ± 0.51 mm.ConclusionOrbital branches from the MMA are highly prevalent and must be accounted for at the time of selecting embolization agents and devices during MMA embolization.Abstract E-263 Figure 1DisclosuresY. Senol: None. M. Asghariahmadabad: None. A. Liu: None. N. Krishnan: None. P. Kumar: None. A. Orscelik: None. T. Jun: None. L. Savastano: None.

BackgroundMiddle meningeal artery embolization (MMAE) has emerged as an alternative to surgical treatment of non-acute subdural hematomas (NASDH). When used in conjunction with surgery, it has previously been shown to reduce recurrence, but its effectiveness as a standalone therapy remains to be established.MethodsWe conducted a propensity score-matched cohort study on 265 consecutive patients with NASDH who underwent either standalone MMAE (sMMAE) or surgical evacuation at our institution. The primary outcome was reintervention due to hematoma resurgence. Secondary outcomes included length of hospital stay, new neurological symptoms, cardiorespiratory, neurological, and other medical adverse events.ResultsAfter matching, 85 patients were allocated in each group. The median age was 73 years, and 20% were female. There was no baseline difference in clinical characteristics at presentation. During a median follow-up of 72 days in the sMMAE group and 59 days in the surgical group, the incidence rate of reintervention did not differ between the two treatments (IRR 1.38, p = .41). Median length of hospitalization was shorter in the sMMAE group (4 days vs. 6 days, p =.003). No differences were observed in new neurological symptoms at 30 days (RR 0.85, p = .71), nor risk of cardiorespiratory (RR .50, p = .327), or neurologic adverse events (RR 0.66, p = .65). Patients treated with sMMAE had a lower risk of other medical adverse events compared to surgery (1.1% vs. 15.2%, RR = .07, p = .013).ConclusionPatients who underwent sMMAE may benefit from a shorter hospitalization and a lower risk of medical adverse events compared to open surgical treatment, without experiencing increased risk of recurrence. Larger studies are warranted to establish the effectiveness of sMMAE in the management of NASDH and to identify the subset of patients that are most likely to benefit from this treatment modality.DisclosuresI. Mesina Estarron: None. J. Ravinob: None. C. Stapleton: None. A. Patel: None. K. Huang: None. R. Regenhardt: None.

IntroductionThe two-step management that combines surgical evacuation of non-acute subdural hematoma (SDH) for rapid brain decompression and middle meningeal artery embolization (MMAe) to prevent re-bleeding as a surgical adjunct is becoming a dominant treatment paradigm of symptomatic SDH. However, this approach requires two different interventions with their associated risks, prolonged ICU and hospital stay and drastically increases medical care costs. A technology was developed for MMAe and endovascular drainage of non-acute SDH. We report the procedural results of the first cohort of consecutive patients treated with this system.MethodsA prospective, single-arm, first-in-human study (EMBODRAIN Study) was conducted to evaluate the safety and feasibility of endovascular drainage of non-acute SDH and MMAe using a purpose-built technology (Endovascular Horizons, Inc) for transvascular access to the intracranial intradural space.ResultsTen (10) consecutive patients (8 males (80%), average age 73.6 years) underwent MMAe and endovascular drainage of SDH. Radiographically, the cohort included sub-acute (n=2), chronic (n=2), acute-on-chronic (n=3), and trabeculated SDH type (n=3). Acute clinical success (defined as MMAe and transvascular drainage of the SDH with no conversion to open surgical drainage) and acute technical success (defined as ability to create a leak-proof transvascular passageway and access the subdural space with a microcatheter, drain the SDH and occlude the MMA) was achieved in all cases (10/10). No Serious Adverse Events (SAE) including death, life-threatening illness or injury, persistent or significant disability or incapacity, or the need for medical or surgical intervention to prevent permanent impairment to a body structure or function were recorded at 30-days. No patient required open surgical drainage. The SDH volume at baseline was an average of 188.1 mL and decreased immediately post-procedurally to an average of 65.5 mL (>65% volumetric reduction). The SDH thickness at baseline was an average of 23.4 mm, and decreased post-procedurally to an average of 14.4 mm. The midline shift at baseline was an average of 9.7 mm and decreased post-procedurally to an average of 4.2 mm. Post-procedural flat panel CT and head CT at 72-hours did not demonstrate interval hemorrhage in any of the cases. The average Modified Rankin Scale Score and Markwalder grade decreased from 2.7 and 1.9 , respectively at presentation to 1.3 and 0.7, respectively at 72hrs post-intervention. There were no recurrence or progression requiring surgery, and no deterioration in neurological function.ConclusionsMMAe and transvascular drainage of a broad range of symptomatic non-acute SDH in a single, fully endovascular procedure is feasible and is associated to rapid radiographic and clinical improvement.DisclosuresP. Lylyk: None. P. Lylyk: None. I. Lylyk: None. C. Bleise: None. N. Perez: None. E. Scrivano: None. J. Lundquist: None. D. Andrist: 5; C; CTO Endovascular Horizons. L. Savastano: 4; C; Founder, Endovascular Horizons. 6; C; Inventor (Royalties agreement).

IntroductionIt is generally believed that antiplatelet effect, especially clopidogrel, reaches and maintain a therapeutic range and plateau within 5–7 days. However, the consistence of clopidogrel effect after stent-assisted coil embolization is unclear.Aim of StudyThe purpose of this study was to evaluate follow-up P2Y12 reaction unit (PRU) in the patients who underwent stent-assisted coil embolization.MethodsThe Patients were administered a dual antiplatelet (100mg of aspirin and 75mg of clopidogrel) for 5 days prior to coil embolization. The follow-up PRU was evaluated between 2 and 4 weeks after stent-assisted coil embolization in the outpatient clinic. To evaluate the predictability of significant variables for a follow-up PRU value less than 80, the receiver-operating characteristic (ROC) curve method was employed. The optimal cutoff value was determined using the Youden index.ResultsA total of 124 patients with 131 aneurysms were included in this study. The median PRU before coil embolization was 155 (IQR 124–181), and the median follow-up PRU after coil embolization was 142 (IQR 92–179). A total of 29 patients (23.4%) had a follow-up PRU value less than 80. The optimal cut-off value of pre-procedural PRU to predict a follow-up PRU value less than 80 was 124.ConclusionThe PRU level after stent-assisted coil embolization can decrease to a hyper-response level despite an acceptable range of the PRU Before Procedure. The significant predictor of hyper-response was the pre-procedural PRU level. The optimal cut-off value of pre-procedural PRU to predict a follow-up PRU value less than 80 was 124.Disclosure of InterestNothing to disclose

IntroductionMechanical thrombectomy (MT) has become a first-line treatment for acute ischemic stroke. Several techniques combining stent retrievers (SR) and distal aspiration catheters (DAC) have been described.Aim of StudyWe aimed to characterize the efficacy of two commonly used techniques according to clot characteristics.MethodsSoft (stiffness = 95.77±5.80 kPa) or stiff (205.63±6.70 kPa) synthetic clots (3x10 mm and 2x10 mm, respectively) were embolized to the distal M1 segment of the middle cerebral artery (MCA) in an in vitro model. The retrieval technique was randomly allocated (1:1): SAVE (partial retraction of SR into DAC) vs. Solumbra (total retraction). Primary endpoint was the percentage of first-pass recanalization (%FPR). Secondary endpoints were periprocedural distal embolization measures.ResultsA total of 130 MTs were performed (50 for soft clots and 15 for stiff clots per arm). Overall, the rate of FPR was 35% with Solumbra and 15% with SAVE (p<0.01). For stiff clots, the FPR was equal for both methods (27%; p=1.00). With soft clots, FPR was higher with Solumbra (38%) than with SAVE (12%; p<0.01). When using soft clots, maximum embolus size (1.19±0.9 mm vs. 2.16±1.48 mm; p<0.01) and total area of emboli (1.82±2.73 vs. 3.34±3.2; p=0.01) were also lower with Solumbra than with SAVE.ConclusionClot characteristics may influence the efficacy of the thrombectomy technique. In occlusions caused by soft clots, complete retrieval into the DAC achieved higher rates of FPR and lower embolization.Disclosure of InterestMagda Jablonska has nothing to disclose.Jiahui Li has nothing to disclose.Riccardo Tiberi has nothing to disclose.Pere Canals has nothing to disclose.Alejandro Tomasello reports receiving consulting fees from Anaconda Biomed, Balt, Medtronic, MicroVention, Cerus, Merlin Medical, and Stryker.Marc Ribo is a consultant for Medtronic, Cerenovus, Vesalio.

Acute gastrointestinal bleeding (GIB) is a critical medical emergency that poses significant risks to patient morbidity and mortality. It can arise from various etiologies, including peptic ulcers, diverticular disease, malignancies, and vascular anomalies. The management of acute GIB has evolved considerably, with interventional radiology (IR) emerging as a vital component in both diagnosis and treatment. This review explores the role of interventional radiology in the management of acute GIB, emphasizing its diagnostic capabilities and therapeutic interventions. Diagnostic angiography is a cornerstone of IR, allowing for the real-time visualization of the vascular supply to the gastrointestinal tract. This technique is particularly beneficial in cases where the source of bleeding is not readily apparent through conventional imaging methods. The ability to identify active bleeding enables targeted therapeutic interventions, such as embolization. Therapeutic embolization involves the selective occlusion of bleeding vessels using various embolic agents, including coils, particles, and liquid agents. This minimally invasive approach has demonstrated high success rates in controlling hemorrhage, with reported efficacy ranging from 70% to 90%. In addition to embolization, stenting is another important IR technique, particularly in cases involving malignant obstruction or strictures. Endovascular stents can restore patency in obstructed vessels, improving blood flow and reducing the risk of further bleeding. The use of stenting has been associated with enhanced patient outcomes, including decreased need for surgical intervention and shorter hospital stays. Despite the advantages of interventional radiology, potential complications such as vessel injury and non-target embolization must be considered. A multidisciplinary approach involving gastroenterologists, surgeons, and interventional radiologists is essential for optimizing patient care. As the field of interventional radiology continues to advance, ongoing research and technological innovations promise to further enhance the management of acute gastrointestinal bleeding, ultimately improving patient safety and outcomes. This review underscores the critical role of interventional radiology in the comprehensive management of acute GIB, highlighting its potential to transform patient care in this challenging clinical scenario.

Among patients with nonacute subdural hematoma, middle meningeal artery embolization led to a 90-day incidence of symptomatic recurrence or progression similar to that with usual care but with fewer serious adverse events.