Middle Meningeal Artery Embolization for Acute and Acute-on-chronic Subdural Hematomas: A Retrospective Cohort Study
Daniel Isaza Pierotti1, Noah Sugg1, Richard Fu1, Taha Nisar1, Muhammad Adeel Saleemi2, Rebecca Sugg1
1The University of South Alabama Medical Center, 2University of South Alabama
Objective:
Retrospective review of middle meningeal artery embolization for acute and acute-on-chronic subdural hematomas.
Background:
The underlying inflammatory response in subdural hematoma (SDH) may promote neoangiogenesis, impair hematoma resorption, and contribute to recurrence. Middle meningeal artery embolization (MMAE) has been proven in multiple trials as a safe and effective way to reduce chronic SDH recurrence. The efficacy of MMAE has not been established in the acute or acute-on-chronic SDH population. We describe the outcomes of this patient population.
Design/Methods:
We conducted a retrospective review of all consecutive patients with acute or acute-on-chronic SDH who underwent MMAE at our institution between July 2022 and June 2025. All data was entered into a secure, de-identified database for descriptive statistical analysis.
Results:
154 MMAE procedures were performed in 121 consecutive patients (median age, 73 years; interquartile range [IQR], 64 to 82); 71.9% male, 60.3% White, 34.7% African American, and 3.3% Asian. 15 (9.7%) were acute, 139 (90.3%) were acute-on-chronic. 88 (57.1%) were unilateral (46 left-sided, 42 right-sided). 33 (42.9%) were bilateral. Two procedure-related complications (1.3%) occurred (facial nerve palsy and femoral artery occlusion).
At 90 days, follow-up imaging and clinical assessment were available for 74 patients (61.2%), corresponding to 96 embolizations (62.3%). Complete radiographic resolution of the SDH was observed in 19 embolizations (19.8%). No patients required surgical rescue or were readmitted for SDH. A total of 8 patients (6.6%) expired within 90 days of the procedure from non-neurologic causes. All showed a reduction in the hematoma size and no symptomatic recurrences were observed.
Conclusions:
MMAE in acute and acute on chronic SDH was associated with low rates of procedural complications, substantial hematoma reduction, low rates of recurrence and readmission, and no requirement for surgical rescue. These findings support the safety and potential effectiveness of MMAE as a treatment option in select patients with acute or acute-on-chronic SDH.
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