{
  "abstract": "Purpose General anesthesia (GA) is commonly used for middle meningeal artery embolization (MMAe), yet conscious sedation (CS) may enable broader access and outpatient pathways. We compared procedural metrics, adjudicated safety outcomes, and discharge disposition between CS and GA in the EMBOLISE trial.Materials and Methods This was a post-hoc analysis of EMBOLISE subjects undergoing surgery plus Onyx MMAe for subacute/chronic subdural hematoma. Subjects were grouped by anesthesia strategy as follows: Surgical Cohort, CS (n=41) versus GA (n=155) and Non-Surgical Cohort, CS (n=18) versus GA (n=80). Outcomes included Clinical Events Committee (CEC)-adjudicated stroke, serious intracranial hemorrhage (ICH), all-cause mortality (at 30 days, 90 days, and study exit at 180 days), retreatment within 90 days, discharge disposition, hospital length of stay, and procedural metrics. Group comparisons used Fisher’s exact test and unpaired t-tests; propensity score-adjusted analyses were performed.Results In the EMBOLISE Surgical Cohort, baseline characteristics were similar between groups except a higher rate of bilateral SDH per core lab in the CS group (41.5% vs 23.9%, p=0.031). MMAe was technically successful in all patients in both groups. Mean Onyx volume (0.78±0.57 vs 0.87±0.68 mL, p=0.43), procedure time (59.0±25.4 vs 65.2±32.1 min, p=0.25), and fluoroscopy time (30.2±11.8 vs 27.9±14.0 min, p=0.32) were similar. Safety outcomes were comparable: serious ICH through 30 days was 2.4% vs 2.6% (p=1.00); stroke through study exit was 2.4% vs 1.9% (p=1.00). All-cause mortality was similar at 30 days (4.9% vs 2.6%, p=0.61), 90 days (7.3% vs 4.5%, p=0.44), and study exit (9.8% vs 6.5%, p=0.50). Retreatment within 90 days was 2.4% vs 4.5% (p=1.00). Discharge home was numerically higher with CS (70.7% vs 62.6%, p=0.37) and mean length of stay was similar (6.7±5.1 vs 7.7±6.4 days, p=0.31). Propensity score-adjusted analyses did not change the findings. Analyses comparing anesthesia strategy in the EMBOLISE Non-Surgical Cohort are ongoing and will be presented at SNIS.Conclusions In this post-hoc analysis of the EMBOLISE trial Surgical Cohort, CS for Onyx MMAe provided comparable adjudicated safety outcomes relative to GA, with similar procedural metrics, hospital length of stay, and a trend toward higher rates of discharge home. These data support CS as a feasible and safe anesthetic strategy for MMAe and motivate prospective evaluation of CS-based outpatient and ambulatory care pathways.Disclosures J. Davies: 1; C; NIH, nVidia, Google. 2; C; Medtronic, Microvention, Imperative Care, Rapid Medical, RapidPulse, Xenter. 4; C; Hyperion, Cerebrotech, QAS.ai, Kantu. R. Harbaugh: None.",
  "authors": [
    {
      "affiliations": [
        "University at Buffalo, Buffalo, NY"
      ],
      "name": "J Davies"
    },
    {
      "affiliations": [
        "Penn State, Hershey, PA"
      ],
      "name": "J Knopman"
    },
    {
      "affiliations": [
        "Penn State, Hershey, PA"
      ],
      "name": "R Harbaugh"
    },
    {
      "affiliations": [
        "Neurology, UTSCHSA Valley Baptist, Harlingen, TX"
      ],
      "name": "A Hassan"
    },
    {
      "affiliations": [
        "UC San Diego Health System, San Diego, CA"
      ],
      "name": "A Khalessi"
    },
    {
      "affiliations": [
        "University at Buffalo, Buffalo, NY"
      ],
      "name": "M Mokin"
    },
    {
      "affiliations": [
        "University of Buffalo, Buffalo, NY"
      ],
      "name": "A Siddiqui"
    }
  ],
  "title": "E-216 Conscious sedation versus general anesthesia for onyx middle meningeal artery embolization in subacute/chronic subdural hematoma: safety and disposition in EMBOLISE",
  "uid": "adce8e9f-c90d-5716-a9a9-23c8b833b906"
}