Gomez-Paz Santiago, Salem Mohamed M, Baker Cordell, Kuybu Okkes, Sioutas Georgios S, Carroll Kate T, Salih Mira, Dmytriw Adam A, Khalife Jane, Smith William, Moreno Diego Alejandro Ortega, Regenhardt Robert W, Cancelliere Nicole M, Spiotta Alejandro M, Tanweer Omar, Stapleton Christopher J, Lang Michael, Pereira Vitor M, Patel Aman B, Siddiqui Adnan H, Levy Elad I, Ogilvy Christopher S, Tonetti Daniel, Thomas Ajith J, Srinivasan Visish M, Jankowitz Brian T, Levitt Michael R, Gross Bradley A, Burkhardt Jan-Karl, Grandhi Ramesh
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA.
Interv Neuroradiol. 2025 May 13:15910199251339536. doi: 10.1177/15910199251339536.
BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43-3.51, < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25-0.69, = 0.001) to be independent at last follow-up.ConclusionThis study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.
背景
我们调查了接受或未接受引流手术的慢性硬膜下血肿（CSDH）患者在进行脑膜中动脉栓塞术（MMAE）后的影像学和临床结果的种族差异。
方法
这项多中心回顾性研究纳入了北美11家机构（美国10家，加拿大1家）连续接受MMAE的患者。根据患者自我报告的种族数据进行分层。感兴趣的结果包括并发症、治疗失败/再次手术、血肿消退以及最后一次随访时的功能独立性。使用多变量回归模型评估和调整相关混杂因素。
结果
共有557例患者接受了663次MMAE，其中包括323例白人（58%）、150例黑人（27%）、35例西班牙裔（6%）、29例亚洲人（5%）患者，以及20例（4%）自我归类为其他/未披露种族的患者。该队列的中位年龄（四分位间距）为75（65 - 81）岁，412例（74%）患者为女性。369例（66%）患者的MMAE是CSDH的主要治疗方法，188例（34%）是辅助治疗。与其他种族相比，黑人患者再次手术的可能性低51%（调整后的优势比[OR]为0.49；95%置信区间[CI]为0.25 - 0.95，P = 0.034）。在最后一次随访时，白人患者独立的可能性是其他患者的两倍（差异为11%；调整后的OR为2.24；95% CI为1.43 - 3.51，P < 0.001），而黑人患者独立的可能性低59%（差异为6%；调整后的OR为0.41；95% CI为0.25 - 0.69，P = 0.001）。
结论
本研究强调了CSDH患者在接受或未接受引流手术的情况下进行MMAE后结果存在显著的种族差异。白人患者再次手术率较高，但在最后一次随访时功能独立的可能性更大。黑人患者尽管基线功能状态较好，但术后功能独立的几率较低。
