Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Real-World Outcomes using Center for Medicare and Medicaid Services Data.

Authors

Ramesh Grandhi, Jared Knopman, Jason Davies, Charlotte Wu, Natasha Shroff, Harsh Sancheti

Published in

AJNR. American journal of neuroradiology. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

Middle meningeal artery (MMA) embolization is an evidence-supported endovascular treatment for chronic subdural hematoma (cSDH). This retrospective study evaluated post-discharge clinical outcomes, healthcare utilization, and payments among patients receiving MMA embolization as an adjunct to surgical evacuation compared with surgery evacuation alone.
Medicare fee-for-service claims from the Centers for Medicare and Medicaid Services were used to identify patients treated in the years 2018 through 2023 for chronic or subacute, non-traumatic subdural hematoma, via surgical evacuation with or without concurrent MMA embolization. Patients were propensity-matched 1:2 using age, sex, region, hospital characteristics, comorbidities, and admission year. The primary outcome was cumulative incidence of readmissions and reinterventions within 180 days post-discharge using Kaplan-Meier survival analysis. Other outcomes included cumulative incidence of post-discharge mortality, infection, and seizure, as well as post-discharge resource utilization and payments.
Among 8,208 eligible patients, propensity matching produced balanced patient cohorts of 1,133 surgery-only patients and 577 patients in the surgery plus MMA embolization group. Surgery plus MMA embolization was associated with significantly lower cSDH-related readmissions compared with surgery-only (10.0% vs 15.8% respectively at 180-day; Hazard Ratio 0.60, 95% CI 0.45-0.82; P<0.001). Cumulative incidence of reintervention was also significantly lower in the surgery plus MMA embolization group (7.2% vs 13.8%; at 180-day; Hazard Ratio 0.51, 95% CI 0.36-0.72; P<0.001) Total healthcare expenditures for all-cause and cSDH-related encounters were significantly lower for surgery plus MMA embolization vs surgery-only. All-cause total payments were $30,504 (95% CI $28,378-$32,790) for surgery-only versus $26,689 (95% CI $24,092-$29,567) for surgery plus MMA embolization (P = 0.04) and, when limited to cSDH-associated encounters, total payments were $9,099 (95%CI $8,139-$10,172) for surgery-only versus $5,409 (95% CI $4,602-$6,358) for surgery plus MMA embolization (P < 0.001). The differences in payment amounts were driven by lower payments for care in the acute-care hospital setting.
In this large Medicare cohort, use of MMA embolization as an adjunct treatment for cSDH was associated with reduced incidence of readmissions and reinterventions, and lower 6-month healthcare expenditures compared with surgical evacuation alone.

PMID:
42648874
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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