MIDDLE meningeal artery embolisation showed no significant reduction in symptomatic recurrence or progression of subdural hematoma but was associated with fewer serious adverse events.
This multicentre, open-label, randomised trial in China investigated the efficacy and safety of middle meningeal artery embolization in patients with symptomatic nonacute subdural hematomas. Participants, who exhibited mass effect without requiring craniotomy, were allocated to burr-hole drainage or nonsurgical care as determined by the attending surgeon. Each group was further randomly assigned to undergo embolisation with liquid embolic material or to receive usual care. The primary objective was to assess symptomatic recurrence or progression of subdural hematoma within 90 days post-randomisation, while secondary outcomes evaluated clinical and imaging changes. Serious adverse events, including death, constituted the safety outcomes.
A total of 722 patients were included in the study, with 360 in the embolisation group and 362 in the usual-care group. Of the patients, 78.3% underwent burr-hole drainage, typically following embolization (99.6% of cases). Symptomatic recurrence or progression occurred in 6.7% of embolisation patients and 9.9% of usual-care patients, with a between-group difference of −3.3 percentage points (95% CI, −7.4 to 0.8; P=0.10). However, the embolization group experienced significantly fewer serious adverse events compared to the usual-care group (6.7% vs. 11.6%, P=0.02).
Although embolisation did not substantially impact recurrence rates within 90 days, its association with a lower incidence of serious adverse events presents a noteworthy safety advantage. Future research could explore strategies to improve recurrence outcomes while retaining this safety profile. Clinicians might consider embolisation as a viable adjunct, particularly in patients prioritising minimised adverse events. Integration of these findings into clinical practice could enhance personalised care approaches, though further studies are essential to establish long-term outcomes.
Reference
Liu J et al. Middle meningeal artery embolization for nonacute subdural hematoma. N Engl J Med. 2024;391:1901-12.
