Embolic Materials' Comparison in Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score-Matched Analysis of 1070 Cases.

Autor:	Salem MM; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Helal A; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA., Gajjar AA; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Sioutas GS; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Khalife J; Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA., Kuybu O; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Caroll K; Department of Neurosurgery, University of Washington, Seattle, Washington, USA., Nguyen Hoang A; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA., Baig AA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA., Salih M; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA., Baker C; Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA., Cortez G; Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA., Abecassis Z; Department of Neurosurgery, University of Washington, Seattle, Washington, USA., Ruiz Rodriguez JF; Department of Neurosurgery, University of Washington, Seattle, Washington, USA., Davies JM; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA., Cawley CM; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA., Riina HA; Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA., Spiotta AM; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA., Khalessi AA; Department of Neurosurgery, University of California-San Diego, La Jolla, California, USA., Howard BM; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA., Hanel R; Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida, USA., Tanweer O; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA., Tonetti DA; Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA., Siddiqui AH; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA., Lang MJ; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Levy EI; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA., Ogilvy CS; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Teaching Hospital, Boston, Massachusetts, USA., Srinivasan VM; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Kan P; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.; Department of Neurosurgery, University of Texas Medical Branch Galveston, Galveston, Texas, USA., Gross BA; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Jankowitz BT; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.; JFK New Jersey Neuroscience Institute, Edison, New Jersey, USA., Levitt MR; Department of Neurosurgery, University of Washington, Seattle, Washington, USA., Thomas AJ; Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA., Grandhi R; Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA., Burkhardt JK; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Oct 17. Date of Electronic Publication: 2024 Oct 17.
DOI:	10.1227/neu.0000000000003218
Abstrakt:	Background and Objectives: Multiple preferences exist for embolic materials selection in middle meningeal artery embolization (MMAE) for chronic subdural hematoma with limited comparative literature data. Herein, we compare different embolic materials. Methods: Consecutive patients undergoing MMAE for chronic subdural hematoma at 14 North-American centers (2018-2023) were classified into 3 groups: (a) particles, (b) Onyx, (c) n-butyl cyanoacrylate (n-BCA). The end points were unplanned rescue surgery, radiographic success (≥50% reduction in hematoma thickness at last imaging "minimum of 2 weeks"), and major complications. Initial unmatched analysis compared the 3 groups; subsequent propensity score matching (PSM) compared particles vs liquid embolics (groups b and c combined). Additional subgroup PSM analyses compared particles vs Onyx, particles vs n-BCA, and Onyx vs n-BCA. All matched analyses controlled for age, sex, concurrent surgery, previous surgery, hematoma thickness, midline shift, pretreatment antithrombotics, and baseline modified Rankin Scale. Results: Eight hundred and seventy-two patients (median age 73 years, 72.9% males) underwent 1070 MMAE procedures. Onyx was most used (41.4%), then particles (40.3%) and n-BCA (15.5%). Surgical rescue rates were comparable between particles, Onyx, and n-BCA (9.8% vs 7% vs 11.7%, respectively, P = .14). Similarly, radiographic success (78.8% vs 79.3% vs 77.4%; P = .91) and major complications (2.4% vs 2.3% vs 2.5%; P = .83) were comparable. The PSM comparing particles vs liquid generated 128 matched pairs; general anesthesia and bilateral procedures were significantly higher in particles (37.8% vs 21.3%; P = .004 and 39.8% vs 27.3%; P = .034, respectively). No differences in surgical rescue, radiographic improvement, or major complications were noted (P > .05). Concurrently, PSM comparing particles vs Onyx, particles vs n-BCA, and Onyx vs n-BCA, resulted in 112, 42, and 40 matched pairs, respectively, without differences in surgical rescue, radiographic success, or major complications (P > .05). Conclusion: We found no differences in radiological improvement, surgical rescue, or major complications between embolic materials in MMAE. Current randomized trials are exclusively using liquid embolics, and these data suggest that future trials involving particles are likely to produce similar outcomes. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu