Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma

Patients undergoing standard treatment for chronic subdural hematoma have a high risk of treatment failure, with recurrence rates ranging from 5% to 50%. This randomized controlled trial (STEM) examined whether middle meningeal artery embolization as an adjunct to standard treatment reduces this risk.

The study enrolled 310 patients, divided into embolization plus standard treatment (n=149) and standard treatment alone (n=161) groups. At 180 days, primary-outcome events (hematoma recurrence, surgical rescue, disabling stroke, or neurological death) occurred in 16% of embolization patients versus 36% in the control group (odds ratio: 0.36; P=0.001). The embolization group showed lower recurrence rates without increased risk of stroke or short-term mortality.

Although embolization significantly reduced treatment failure, it did not affect overall mortality at 180 days. Long-term safety assessments are needed to evaluate its full impact on patient outcomes.

Patients undergoing standard treatment for chronic subdural hematoma have a high risk of treatment failure, with recurrence rates ranging from 5% to 50%. This randomized controlled trial (STEM) examined whether middle meningeal artery embolization as an adjunct to standard treatment reduces this risk.

The study enrolled 310 patients, divided into embolization plus standard treatment (n=149) and standard treatment alone (n=161) groups. At 180 days, primary-outcome events (hematoma recurrence, surgical rescue, disabling stroke, or neurological death) occurred in 16% of embolization patients versus 36% in the control group (odds ratio: 0.36; P=0.001). The embolization group showed lower recurrence rates without increased risk of stroke or short-term mortality.

Although embolization significantly reduced treatment failure, it did not affect overall mortality at 180 days. Long-term safety assessments are needed to evaluate its full impact on patient outcomes.