Chen Huanwen, McIntyre Matthew K, Kan Peter, Gandhi Dheeraj, Colasurdo Marco
From the Department of Neurology (H.C.), MedStar Georgetown University Hospital, Washington, DC.
Department of Neurosurgery (M.K.K.), Oregon Health & Science University, Portland, Oregon.
AJNR Am J Neuroradiol. 2025 Sep 11. doi: 10.3174/ajnr.A8781.
Middle meningeal artery embolization (MMAE) has emerged as a novel treatment for non-acute subdural hematoma (SDH), particularly for reducing the risk of SDH recurrence. Recently, 5 randomized controlled trials (RCTs) of MMAE as an adjunct to conventional management (surgical or observant) have concluded their investigation and reported their outcomes.
Our goal was to synthesize trial results to provide more definitive guidance on the role of MMAE in the management of non-acute SDH.
The MEDLINE database from inception up to November 23, 2024 was used. English-language clinical articles reporting large randomized controlled trials ( = 100 or more) investigating the efficacy and safety of MMAE for patients with non-acute subdural hematoma were identified.
Five trials were identified-EMBOLISE, STEM, MAGIC-MT, EMPROTECT, and MEMBRANE.
The primary efficacy end point was SDH treatment failure (broadly defined as SDH recurrence or requirement of surgical rescue) within 3 to 6 months. Safety end points include death and stroke.
There was significant heterogeneity in terms of patient populations as well as reported outcomes. Overall, MMAE was associated with significantly lower odds of SDH treatment failure (OR 0.51 [95% CI 0.39-0.67], < .001), with minimal inter study heterogeneity. Compared with conventional management, MMAE was not significantly associated with different odds of death (OR 1.03 [95% CI 0.36-2.99], = .95) or stroke (OR 1.10 [95% CI 0.36-3.39], = .86).
Our meta-analysis is limited by selection bias and high heterogeneity in study design and reported outcomes.
This study provides high-level evidence that, for patients with non-acute SDH, MMAE is a safe and effective adjunct to conventional management for preventing treatment failure.
脑膜中动脉栓塞术（MMAE）已成为一种治疗非急性硬膜下血肿（SDH）的新方法，尤其可降低SDH复发风险。最近，5项关于MMAE作为传统治疗（手术或观察）辅助手段的随机对照试验（RCT）完成了研究并报告了结果。
我们的目标是综合试验结果，为MMAE在非急性SDH治疗中的作用提供更明确的指导。
使用了自建库至2024年11月23日的MEDLINE数据库。检索到了报告大型随机对照试验（样本量=100或更多），研究MMAE对非急性硬膜下血肿患者疗效和安全性的英文临床文章。
确定了5项试验——EMBOLISE、STEM、MAGIC-MT、EMPROTECT和MEMBRANE。
主要疗效终点为3至6个月内SDH治疗失败（广义定义为SDH复发或需要手术挽救）。安全性终点包括死亡和中风。
在患者人群和报告的结果方面存在显著异质性。总体而言，MMAE与SDH治疗失败几率显著降低相关（OR 0.51 [95%CI 0.39-0.67]，P<0.001），研究间异质性最小。与传统治疗相比，MMAE与死亡几率（OR 1.03 [95%CI 0.36-2.99]，P = 0.95）或中风几率（OR 1.10 [95%CI 0.36-3.39]，P = 0.86）无显著差异。
我们的荟萃分析受选择偏倚以及研究设计和报告结果的高度异质性限制。
本研究提供了高级别证据，对于非急性SDH患者，MMAE是预防治疗失败的传统治疗的安全有效辅助手段。
