The primary objective of this research is to compare and evaluate the effectiveness of various endovascular embolization techniques for the treatment of chronic Subdural Hematoma (SDH).

Chronic SDH is a common pathology with high recurrence rate, especially in elderly and patients on antithrombotic medication. Minimally invasive treatment of SDH with Middle Meningeal Artery (MMA) embolization has been rapidly developed for a decade. However, the clinical practice guidelines for this procedure are not standardized due to limited comparative data and controversy on which embolic agent is superior.

This is a retrospective cohort study of approximately 500 adult patients (>18 years) with chronic SDH who were treated with one of four specified embolic agents via embolization between the years 2018 and 2024 across multiple medical centers. Patients must have follow-up data available at both 30 and 90 days following the procedure to be included. The primary outcome is SDH resolution rate. Secondary outcomes include the rate of recurrence, rate of subsequent surgery, and 90-day mRS score. Statistical analysis is performed using multivariate regression and Cox proportional hazards modeling to control for potential confounding variables such as age, anticoagulation status, and hematoma volume.

The study aims towards a statistically significant difference (p<0.05) in both the rate of SDH resolution and recurrence between the different embolization techniques. Additionally, it is thought that patients who underwent embolization alone had a lower rate of subsequent surgery.

This study provides high-quality, comparative data for clinical application and treatment strategy optimization in chronic SDH patients. By identifying the most effective approach to embolization, this research has the potential to answer an important clinical question in neurointerventional practice and improve patient outcomes by maximizing hematoma resolution, reducing recurrence, and optimizing recovery.