{
  "abstract": "Background and Objective Single-session middle meningeal artery embolization (MMAE) combined with surgical evacuation is an emerging strategy for management of patients with chronic subdural hematoma (cSDH). However, comparative outcome data based on embolic material selection in this setting remain limited. We compared clinical, radiographic, and functional outcomes of patients treated with cSDH using liquid or particle embolic agents and evaluated the effect of adjunctive coil use.Methods We conducted a retrospective multicenter cohort study of consecutive adults undergoing single-session MMAE with surgical evacuation for cSDH. Outcomes were compared by embolic material (liquid vs. particle) using 1:1 propensity score matching. The impact of adjunctive coiling was assessed in the overall cohort. Associations were evaluated using multivariable logistic regression and reported as odds ratios with 95% confidence intervals.Results Among 268 identified patients, 100 (50 liquid and 50 particle) were propensity-score matched for analysis. Rates of improved or stable functional status at last follow-up were similar between liquid (79.2%) and particle embolization (72.5%) groups (p=.701), as were ≥50% hematoma reduction (66.0% vs 72.0%, p=.464), postoperative complications (6.0% vs 8.0%, p=.672), and all-cause mortality (14.0% vs 14.0%, p=.951). Particle embolization was associated with a higher rate of needing any re-evacuation (20.0% vs. 6.0%; adjusted odds ratio 5.13, 95% confidence interval=1.12–23.42, p=.035). Adjunct coiling lengthened procedure duration (203 [187–269] vs. 198 [163–232] minutes, p=.019) without significant differences in clinical, radiographic, or adverse outcomes.Conclusions In patients undergoing single-session MMAE with surgical evacuation for cSDH, liquid and particle embolic agents demonstrated comparable safety and functional and radiographic efficacy. However, liquid embolization was associated with significantly fewer reinterventions. Adjunctive coiling lengthened procedural time without differences in clinical or radiographic outcomes. Prospective comparative studies are needed to further define the role of embolic material and technical factors in patients undergoing evacuation and MMAE.Disclosures I. Christie: None. D. Pichardo-Rojas: None. S. Gomez-Paz: None. K. Richter: None. A. Mcnulty: None. N. Kendall: None. A. Paul: None. W. Gregory: None. J. Burkhardt: None. V. Srinivasan: None. B. Jankowitz: None. M. Levitt: 1; C; Medtronic, Stryker. 2; C; Aeaean Advisers, Metis Innovative, Genomadix, AIDoc, Phenox, Shepherd Vascular, Arsenal Medical. 4; C; Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron, Hyperion Surgical. D. Felbaum: None. M. Salem: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "I Christie"
    },
    {
      "affiliations": [
        "Instituto Nacional de Neurología y Neurocirugía ‘Manuel Velasco Suárez’, Mexico City, Mexico, Mexico City, MEXICO"
      ],
      "name": "D Pichardo-Rojas"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "S Gomez-Paz"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA"
      ],
      "name": "K Richter"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, WA"
      ],
      "name": "M McGrath"
    },
    {
      "affiliations": [
        "Neurosurgery, MedStar Georgetown University Hospital, Washington, DC"
      ],
      "name": "J Breton"
    },
    {
      "affiliations": [
        "Georgetown University School of Medicine, Washington, DC"
      ],
      "name": "S Wakelin"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Albany Medical Center, Albany, NY"
      ],
      "name": "A Mcnulty"
    },
    {
      "affiliations": [
        "Sanford School of Medicine, University of South Dakota, Sioux Falls, SD"
      ],
      "name": "N Kendall"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Department of Neurosurgery, Albany Medical Center, Albany, NY"
      ],
      "name": "A Paul"
    },
    {
      "affiliations": [
        "Geisinger Health System, wilkes barre, PA"
      ],
      "name": "A Aljuboori"
    },
    {
      "affiliations": [
        "Geisinger, Danville, PA"
      ],
      "name": "P Hendrix"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA"
      ],
      "name": "W Gregory"
    },
    {
      "affiliations": [
        "Baylor College of Medicine, Houston, TX"
      ],
      "name": "E Duckworth"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "J Burkhardt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA"
      ],
      "name": "V Srinivasan"
    },
    {
      "affiliations": [
        "Stroke and Neurovascular Program, Hackensack Meridian Neuroscience Institute, JFK University Medical Center, Edison, NJ"
      ],
      "name": "B Jankowitz"
    },
    {
      "affiliations": [
        "JFK University Medical Center - Hackensack Meridian Health, Edison, NJ"
      ],
      "name": "T Snyder"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, WA"
      ],
      "name": "M Levitt"
    },
    {
      "affiliations": [
        "Washington Hospital Center, Washington, DC"
      ],
      "name": "R Armonda"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, MedStar Georgetown University Hospital, Washington DC, DC"
      ],
      "name": "D Felbaum"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA, Aurora, CO"
      ],
      "name": "M Salem"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Utah, Salt Lake City, UT"
      ],
      "name": "R Grandhi"
    }
  ],
  "title": "E-260 Comparative efficacy of embolic agents for single-session meningeal artery embolization and surgical evacuation: evaluating liquids, particles, and adjunct coils",
  "uid": "83f38427-042b-5b1e-bb57-697f969748c8"
}