{
  "abstract": "Background Middle meningeal artery embolization (MMAE) is increasingly used for chronic subdural hematoma (cSDH). Alcohol use and liver disease are prevalent among cSDH patients and may affect coagulation and treatment response, yet their combined effect on MMAE outcomes is unknown.Methods From the multicenter MESH Registry, 1,190 patients with complete exposure data were classified into three groups: neither alcohol use nor liver disease (n=739, reference), alcohol only (n=408), and alcohol with liver disease (n=43). Outcomes included reoperation, hematoma recurrence, composite treatment failure, good functional outcome (mRS 0-2), and mortality. Inverse probability of treatment weighting (IPTW) using multinomial propensity scores (7 confounders) balanced baseline characteristics. Risk ratios with 95% CIs were estimated via 10,000-iteration bootstrap with Benjamini-Hochberg correction.Results Patients with alcohol and liver disease had higher thrombocytopenia (44.2% vs 9.2%, P<0.001) and chronic anemia (48.8% vs 12.8%, P<0.001). After IPTW adjustment, alcohol alone was not associated with different outcomes across all five endpoints. Alcohol with liver disease was associated with significantly lower mortality (2.7% vs 12.4%; RR, 0.22; 95% CI, 0.00-0.60; P<0.001) and lower recurrence (0.6% vs 3.7%; RR, 0.17; 95% CI, 0.00-0.69; P=0.007); both remained significant after FDR correction. No significant differences were observed for reoperation (RR, 2.09; P=0.40), composite failure (RR, 1.20; P=0.85), or functional outcome (RR, 0.98; P=0.95). Liver disease without alcohol (n=46) showed markedly higher mortality (30.8%). Interaction analysis revealed significant antagonistic interaction for mortality (RERI, −2.06; 95% CI, −3.77 to −0.35; P=0.02) ( figure 1).Conclusions Alcohol use alone did not adversely affect MMAE outcomes for cSDH. Alcohol with liver disease was not associated with worse outcomes and showed lower mortality and recurrence, likely reflecting survivor selection in patients deemed fit for intervention. Isolated liver disease conferred elevated mortality. These findings suggest alcohol use with liver disease should not be considered a contraindication to MMAE.Disclosures B. Demessie: None. H. Salim: None. M. Collaborators: None.Abstract E-192 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "B Demessie"
    },
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "M Essibayi"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Toronto, Toronto, ON, Canada"
      ],
      "name": "A Karandish"
    },
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "H Salim"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Toronto, Toronto, ON, Canada"
      ],
      "name": "A Dmytriw"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Altschul"
    },
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "M Collaborators"
    }
  ],
  "title": "E-192 Effect of alcohol use and liver disease on treatment outcomes after middle meningeal artery embolization for chronic subdural hematoma",
  "uid": "86c01057-cc19-58c2-a292-f7bacbf56ce9"
}