Journal Article

E-147 Primary coil embolization of the middle meningeal artery for management of nonacute subdural hemorrhage (NASDH)

Abramyan, A, Afridi, M, Roychowdhury, S, Sundararajan, S, Nourollah-Zadeh, E, Sun, H, Soliman, A, Gupta, G

2025

Overview

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.

• Publisher: BMJ Publishing Group LTD
• Subject: Embolization