Year: 2024
Type: conference-abstract
Abstract: Introduction/Purpose The efficacy of middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) has been demonstrated. The initial technique was described using polyvinyl alcohol (PVA) particles, but over time, other embolic agents have been applied. Comparative studies have shown polyvinyl alcohol (PVA) particles are as safe and efficacious as liquid embolisate, though a comparison of particle size has yet to be done. The theory behind particle embolization of the MMA relies on penetration and occlusion of neovascularity in subdural membranes. Particle size may be a factor in the embolization of vascular membranes and subsequent reduction in cSDH size. This study aims to assess the efficacy of 45–150 micron particles as compared to 150–250 micron particles for MMA embolization. Materials and Methods A retrospective review was conducted at a single academic institution. Patients were included who underwent middle meningeal artery embolization for subdural hematoma from 2020–2022. Medical records were reviewed for patient demographics, medical comorbidities, nature of symptoms, and procedural details. Radiographic data was collected from imaging review for thickness of subdural hematoma in greatest dimension prior to the procedure and at most recent follow-up. Results A total of 63 patients were identified and 59 were included, 15 were female. Thirty-three patients (55.9%) were treated with 45–150 micron particles and 26 patients (46.1%) were treated with 150–250 micron particles. There was not a significant difference in age between groups (74.2 ± 9.9 years in the 45–150 micron group versus 71.9 ± 7.8 years, p=0.345). The 45–150 micron group has a lesser prevalence of stroke history comparatively (p=0.034), but there were no other statistically significant differences in medical comorbidities between groups. The average SDH thickness between groups was similar (16.8 mm ± 5.3 mm in the 45–150 micron group versus 15.2 mm ± 6.8 mm in the 150–250 micron group, p=0.326). Anticoagulant and antiplatelet use was not statistically significant between groups. There were no significant differences between post-procedural adverse events. In the 45–150 micron group, 3 patients (9.1%) required retreatment (defined as rescue surgery) and 3 patients in the 150–250 micron group required retreatment (p=0.836). In the 45–150 micron group, 16 patients (48.5%) had decrease in SDH size by 50% or greater at last follow up, and 17 patients (65.4%) in the 15–250 micron group had decrease in SDH size at last follow up (p=0.212). On univariate analysis, particle size did not show any statistically significant impact on need for retreatment or subdural thickness reduction. Discussion This single center retrospective study did not show any difference in outcomes in MMA embolization patients when treated with 45–150 micron PVA particles compared to 150–250 micron PVA particles. Though the cost difference between PVA particles is marginal, larger studies should be undertaken to evaluate particle size and outcomes. Disclosures V. Shah: None. J. Shepherd: None. A. Azghadi: None. Q. Nguyen: None. D. Defta: None. J. Sirinit: None. B. Hika: None. M. Huerta: None. S. Amin-Hanjani: None. A. Ray: None. Y. Hu: None.
Authors: V Shah, J Shepherd, A Azghadi, Q Nguyen, D Defta, J Sirinit, B Hika, M Huerta, S Amin-Hanjani, A Ray, Y Hu
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4400892887