Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Patients with Coagulopathies.

Authors

Muhammed Amir Essibayi, Abdulrhman Alsalama, Anthony P Terraciano, Vidhi Dhaduk, Jay Kakadiya, Bluyé Demessie, Ahmed Y Azzam, Hamza Adel Salim, Mohamed Emara, Huanwen Chen, Dheeraj Gandhi, David J Altschul, Dhairya A Lakhani

Published in

AJNR. American journal of neuroradiology. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

Impaired hemostasis complicates chronic subdural hematoma, raising the risk of both hematoma progression and procedural bleeding. We evaluated whether middle meningeal artery embolization improves 90-day outcomes compared with medical management or surgery alone in coagulopathic patients, and coagulopathy's prognostic impact.
Retrospective cohort study using the TriNetX US Collaborative Network (65 healthcare organizations), reported per STROBE. Adults with chronic subdural hematoma diagnosed on or after January 1, 2016 were identified by ICD-10-CM codes; coagulopathy was defined by coagulation defects, purpura, or other hemorrhagic conditions (D65-D69). Treatment was assigned from procedures occurring 1 day before to 7 days after the index diagnosis. Four 1:1 propensity-score-matched comparisons assessed 90-day mortality and rescue surgery.
Among coagulopathic patients, embolization was associated with lower 90-day mortality than medical management (18.8% versus 26.6%; HR 0.64; 95% CI, 0.52-0.80) and, added to surgery, lower mortality than surgery alone (8.8% versus 20.3%; HR 0.40; 95% CI, 0.27-0.59); both p < 0.001. Rescue surgery did not differ (8.6% versus 6.6%; 13.3% versus 16.5%; both p = 0.22). Coagulopathy was associated with higher mortality and more rescue surgery among medically managed (22.8% versus 15.6%; 2.9% versus 2.3%) and surgical patients (24.8% versus 17.7%; 15.4% versus 11.1%); all p < 0.001.
Embolization was associated with substantially lower 90-day mortality in coagulopathic chronic subdural hematoma, both as standalone treatment and as a surgical adjunct, although short-term rescue surgery was not reduced. Coagulopathy remained an adverse prognostic factor regardless of treatment. Prospective confirmation is required.

PMID:
42642211
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.