Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma

作者：Jianmin Liu, Wei Ni, Qiao Zuo, Heng Yang, Ya Peng, Zhiqing Lin, Zhenbao Li, Jiyue Wang, Yong Zhen, Jing Luo, Yuanxiang Lin, Jian Chen, Xuming Hua, Hua Lu, Ming Zhong, Mingfa Liu, Jianmin Zhang, Yang Wang, Jieqing Wan, Liang Li, Tianxiao Li, Guohua Mao, Wenyuan Zhao, Liang Gao, Conghui Li, Man Chen, Xin Cheng, Ping Zhang, Zigao Wang, Lei Chen, Yongxin Zhang, Bing Tian, Fang Shen, Lei Yu, Yina Wu, Yanjiang Li, Guoli Duan, Liquan Xu, Nan Lv, Jian Yu, Xiaolong Xu, Zhuoying Du, Hongjian Zhang, Jin Hu, Zifu Li, Qiang Yuan, Yu Zhou, Gang Wu, Lei Zhang, Chao Gao, Dongwei Dai, Xuehai Wu, Yongwei Zhang, Hanqiang Jiang, Rui Zhao, Jiabin Su, Yi Xu, Johanna M. Ospel, Charles B.L.M. Majoie, Mayank Goyal, Qiang Li, Pengfei Yang, Yuxiang Gu, Ying Mao · 发表于：New England Journal of Medicine · 年份：2024 · DOI：10.1056/nejmoa2401201 · 被引用次数：218 · 研究领域：Neurosurgical Procedures and Complications、Traumatic Brain Injury and Neurovascular Disturbances、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND: The effect of embolization of the middle meningeal artery in patients with subacute or chronic subdural hematoma is uncertain. METHODS: We performed a multicenter, open-label, randomized trial in China, involving patients with symptomatic nonacute subdural hematoma with mass effect. Patients were assigned to undergo burr-hole drainage or receive nonsurgical treatment at the surgeon's discretion, and patients in each group were then randomly assigned, in a 1:1 ratio, to undergo middle meningeal artery embolization with liquid embolic material or to receive usual care. Patients whose condition warranted craniotomy were excluded. The primary outcome was symptomatic recurrence or progression of subdural hematoma within 90 days after randomization. Secondary outcomes included clinical and imaging outcomes. The main safety outcome was any serious adverse event (including death). RESULTS: The analysis included 722 patients, of whom 360 were assigned to the embolization group and 362 to the usual-care group. Burr-hole drainage was performed in 78.3% of the enrolled patients; among the patients who underwent burr-hole drainage, the procedure occurred after embolization in 99.6%. Symptomatic recurrence or progression of subdural hematoma within 90 days occurred in 24 patients (6.7%) in the embolization group and in 36 (9.9%) in the usual-care group (between-group difference, -3.3 percentage points; 95% confidence interval, -7.4 to 0.8; P = 0.10). The incidence of serious ad...