{
  "abstract": "Introduction/Purpose Subdural hematomas (SDHs) are among the most common neurosurgical conditions, particularly in elderly patients. Standard treatment includes surgical evacuation (burr holes or craniotomy) and, more recently, middle meningeal artery embolization (MMAe) to reduce recurrence. These approaches are typically performed as separate procedures, often under general anesthesia, introducing inefficiencies, procedural risk, and barriers to care—especially in frail or medically complex patients. We developed a novel endovascular approach enabling single-session, fully transvascular treatment of non-acute SDH, integrating MMA embolization with catheter-based subdural evacuation through the same arterial access. A dedicated device system enables controlled perforation of the arterial wall and dura, allowing catheter navigation into the subdural space for hematoma drainage. We report interim safety, feasibility, and early clinical outcomes.Materials and Methods In a prospective, single-arm, first-in-human study (EMBODRAIN), 15 consecutive patients with symptomatic non-acute SDH were enrolled. Two patients were excluded due to unfavorable anatomy (diminutive MMA, n=1; MMA originating from the ophthalmic artery, n=1). All procedures were performed using a dedicated endovascular system enabling MMA embolization followed by transarterial access to the subdural space and hematoma drainage. Technical success was defined as successful embolization, safe access to the subdural space, effective hematoma drainage, and vessel closure without complications. Clinical success was defined as symptomatic improvement and hematoma resolution without need for surgical conversion. Patients were followed clinically and radiographically through 6 months.Results Fifteen patients (mean age 75.6 years; 67% male) underwent successful embolization and transvascular drainage. Technical success was achieved in all cases, with no intraoperative complications or need for surgical conversion. Mean SDH volume decreased by >90%. Midline shift improved from 7.7 ± 4.1 mm to 0.25 ± 0.87 mm. Functional outcomes improved rapidly, with mean modified Rankin Scale scores decreasing from 1.56 to 1.19 and Markwalder Grading Scale scores from 1.81 to 0.75 within 72 hours. There were no hemorrhagic complications, neurological deterioration, or radiographic recurrence at 30 days. No patients required ICU admission or anticoagulation reversal.Conclusions This first-in-human experience demonstrates the safety, technical feasibility, and early clinical effectiveness of a fully endovascular approach for treatment of non-acute SDH. By integrating embolization and hematoma evacuation into a single transvascular procedure, this strategy offers a streamlined, minimally invasive alternative to conventional surgical paradigms. Beyond SDH, this platform establishes the foundation for transvascular neurosurgery, a novel paradigm leveraging endovascular access to treat traditionally non-vascular intracranial pathologies. Further clinical evaluation is warranted.Disclosures P. Lylyk: None. I. Lylyk: None. N. Perez: None. E. Scrivano: None. C. Bleise: None. P. Lylyk: None.",
  "authors": [
    {
      "affiliations": [
        "Endovascular Neurosurgery, ENERI - Clínica la Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "P Lylyk"
    },
    {
      "affiliations": [
        "Endovascular Neurosurgery, ENERI - Clínica la Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "I Lylyk"
    },
    {
      "affiliations": [
        "Endovascular Neurosurgery, ENERI - Clínica la Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "N Perez"
    },
    {
      "affiliations": [
        "Endovascular Neurosurgery, ENERI - Clínica la Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "E Scrivano"
    },
    {
      "affiliations": [
        "Endovascular Neurosurgery, ENERI - Clínica la Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "C Bleise"
    },
    {
      "affiliations": [
        "Neurosurgery, University of California San Francisco, San Francisco, CA"
      ],
      "name": "L Savastano"
    },
    {
      "affiliations": [
        "Endovascular Neurosurgery, ENERI - Clínica la Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "P Lylyk"
    }
  ],
  "title": "O-022 Interim results of the embodrain clinical trial: combined middle meningeal artery embolization and transvascular drainage for non-acute subdural hematoma",
  "uid": "f6d483ce-fbdb-5d7e-837e-9087b7f1ec88"
}