{
  "abstract": "Introduction Distal penetration of the chronic subdural hematoma (cSDH) microvascular bed with liquid embolics or particles is often considered the goal of middle meningeal artery embolization (MMAe). However, growing evidence suggests that embolization using coils alone may provide comparable efficacy with a favorable safety profile. Existing data are largely derived from self-reported outcomes. We present a multicenter, core-lab-adjudicated analysis of stand-alone coil-based MMAe using Penumbra SwiftPAC coils.Methods A multicenter registry of patients undergoing MMAe with SwiftPAC coils was reviewed. Patients receiving adjunct liquid embolics or particles were excluded. Imaging outcomes were adjudicated by an independent core lab (New England Imaging Core Lab). The primary outcome was the rescue treatment rate, defined as cSDH recurrence or growth requiring re-treatment within 180 days. Secondary outcomes included changes in hematoma thickness, volume, and midline shift (MLS).Results A total of 101 embolizations in 80 patients were included (mean age 72.1 ± 10.6 years; 70% male). Most patients had baseline mRS 0-2 (77.6%), and 57.5% underwent upfront hematoma evacuation. Median pre-procedural hematoma thickness was 13 mm (IQR 10-16.1) and median MLS was 2.1 mm (IQR 0-4.5). Procedures were performed via radial or femoral access, with a median of 3 coils placed.Mean radiographic follow-up duration was 91 days. Postoperative metrics demonstrated a median hematoma thickness of 6 mm (IQR 2-9.3) . Median percentage thickness reduction was 53.3% (IQR 30.2-90.3). Complete radiographic resolution occurred in 25 embolizations (24.8%), and ≥50% reduction in thickness was observed in 52 embolizations (51.5%). No procedural complications were reported. Rescue treatment occurred in 8/75 patients (10.7%; missing data in 5 patients).In the subgroup without upfront surgery (45 embolizations), ≥50% thickness reduction occurred in 19 cases (42.2%), with a rescue treatment rate of 0%. There were no significant differences in radiographic outcomes between proximal and distal coil placement.Conclusion In this multicenter, core-lab-adjudicated analysis, stand-alone MMA coil embolization demonstrated favorable radiographic improvement, low rescue treatment rates, and an excellent safety profile, with no reported procedural complications. These updated interim results support primary coil embolization as a safe and effective MMAe strategy; ongoing enrollment and longer-term follow-up are needed to further validate durability of outcomes.Disclosures N. Goyal: None. H. Hoffman: None. J. Sims: None. C. Nickele: None. V. Inoa: None. M. Webb: None. G. Naratadam: None. C. Cisneros: None. C. Munro: None. D. Rosenbaum-HaLevi: None. A. Reeves: None. M. Abraham: None. S. McPherson : None. M. Gray: None. N.K. Khattar: None. T. Nguyen: None. M. Abdalkader: None. J. Mascitelli: None.Abstract E-163 Table 1Clinical, radiographie, procedural, and outeome characteristics",
  "authors": [
    {
      "affiliations": [
        "University of Tennessee Health Science Center, Memphis, TN",
        "Semmes-Murphey Clinic, Memphis, TN"
      ],
      "name": "N Goyal"
    },
    {
      "affiliations": [
        "Neurosurgery, SUNY Upstate Medical University, Syracuse, NY"
      ],
      "name": "H Hoffman"
    },
    {
      "affiliations": [
        "University of Tennessee Health Science Center, Memphis, TN"
      ],
      "name": "J Sims"
    },
    {
      "affiliations": [
        "Semmes-Murphey Clinic, Memphis, TN"
      ],
      "name": "C Nickele"
    },
    {
      "affiliations": [
        "Semmes-Murphey Clinic, Memphis, TN"
      ],
      "name": "V Inoa"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX"
      ],
      "name": "M Webb"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX"
      ],
      "name": "G Naratadam"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX"
      ],
      "name": "C Cisneros"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX"
      ],
      "name": "C Munro"
    },
    {
      "affiliations": [
        "Munson Healthcare, Traverse City, MI"
      ],
      "name": "D Rosenbaum-HaLevi"
    },
    {
      "affiliations": [
        "University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "A Reeves"
    },
    {
      "affiliations": [
        "University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "M Abraham"
    },
    {
      "affiliations": [
        "St. Dominic Memorial Hospital, Jackson, MS"
      ],
      "name": "S McPherson"
    },
    {
      "affiliations": [
        "St. Dominic Memorial Hospital, Jackson, MS"
      ],
      "name": "M Gray"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Mississippi Medical Center, Jackson, MS"
      ],
      "name": "A Strickland"
    },
    {
      "affiliations": [
        "Neurosurgery, St. Bernard Medical Center, Jonesboro, AR"
      ],
      "name": "NK Khattar"
    },
    {
      "affiliations": [
        "Boston Medical Center, Boston, MA"
      ],
      "name": "T Nguyen"
    },
    {
      "affiliations": [
        "Boston Medical Center, Boston, MA"
      ],
      "name": "M Abdalkader"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX"
      ],
      "name": "J Mascitelli"
    }
  ],
  "title": "E-163 Closable: a core lab adjudicated analysis of standalone coil embolization of the middle meningeal artery using swiftpac coils for treatment of chronic subdural hematoma: a multicenter study",
  "uid": "ceb3dca4-068b-5207-a70a-8667e5682bf0"
}