Comparison of proximal coil embolization versus distal middle meningeal artery embolization for the treatment of chronic subdural hematomas.

Background: Multiple trials have recently been published evaluating middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematomas (SDHs). All trials, however, have assessed distal embolization with liquid embolic while many retrospective reviews have evaluated distal embolization with polyvinyl alcohol (PVA) particles. The present study sought to compare the efficacy and safety of proximal coil MMAE with the efficacy and safety of distal embolization. Methods: A prospectively collected, retrospectively analyzed database was queried for patients undergoing MMAE. Patients were subdivided into cohorts based on treatment modality: distal embolization with PVA particles or proximal coil embolization. The electronic medical record was reviewed to obtain demographic, surgical, and outcome data, and these data were compared. Additional subgroups were created to separately compare patients undergoing only embolization as well as patients undergoing surgical decompression with embolization. Results: Ninety-five patients with 122 SDH were identified. No significant difference was identified between groups demographically; however, there was a significant decrease in fluoroscopy with unilateral proximal embolization (14.0 min vs. 17.2 min, P = 0.037) and a nonstatistical reduction in the number of embolic complications (0 vs. 4, P = not significant). In addition, there was no difference in the rate of SDH improvement at 3-month postprocedure or last follow-up. These findings were also true for patients treated with only embolization but not for the group treated with surgical decompression and embolization (likely due to small sample size). Conclusion: Proximal MMAE is noninferior to distal embolization with a decrease in fluoroscopy time and a potential reduction in embolic complications.