J Cerebrovasc Endovasc Neurosurg.  2024 Mar;26(1):1-12. 10.7461/jcen.2023.E2023.04.002.

Safety and efficacy comparison of embolic agents for middle meningeal artery embolization for chronic subdural hematoma

• Ellens NR
• Schartz D
• Kohli G
• Rahmani R
• Akkipeddi SMK
• Mattingly TK
• Bhalla T
• Bender MT

• KMID: 2554041
• DOI: http://doi.org/10.7461/jcen.2023.E2023.04.002

Abstract

Objective
To perform a systematic review and meta-analysis evaluating the efficacy of middle meningeal artery embolization in terms of both clinical and radiographic outcomes, when performed with different embolic agents.
Methods
A systematic literature review and meta-analysis was performed to evaluate the impact of embolic agents on outcomes for middle meningeal artery (MMA) embolization. The use of polyvinyl alcohol (PVA) with or without (±) coils, N-butyl cyanoacrylate (n-BCA) ± coils, and Onyx alone were separately evaluated. Primary outcome measures were recurrence, the need for surgical rescue and in-hospital periprocedural complications.
Results
Thirty-one studies were identified with a total of 1,134 patients, with 786 receiving PVA, 167 receiving n-BCA, and 181 patients receiving Onyx. There was no difference in the recurrence rate (5.5% for PVA, 4.5% for n-BCA, and 6.5% for Onyx, with P=0.71) or need for surgical rescue (5.0% for PVA, 4.0% for n-BCA, and 6.9% for Onyx, with P=0.89) based on the embolic agent. Procedural complications also did not differ between embolic agents (1.8% for PVA, 3.6% for n-BCA, and 1.6% for Onyx, with P=0.48).
Conclusions
Rates of recurrence, need for surgical rescue, and periprocedural complication following MMA embolization are not impacted by the type of embolic agent utilized. Ongoing clinical trials may be used to further investigate these findings.

Keyword

Chronic subdural hematoma; Embolization; Embolic agent; Endovascular procedures; Middle meningeal artery

Figure

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  Fig. 1. Summary of the expert panel consensus for follow-up imaging after endovascular treatment (EVT) of intracranial aneurysms

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