STEM
Trial question
What is the role of adjunctive middle meningeal artery embolization in patients with symptomatic chronic subdural hematoma?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 310
310 patients (94 female, 216 male).
Inclusion criteria: patients with symptomatic chronic subdural hematoma.
Key exclusion criteria: mRS score > 1 before symptoms related to the hematoma developed; prior craniotomy for hematoma; need for urgent/emergent subdural hematoma evacuation; life expectancy < 1 year; intracranial mass other than subdural hematoma.
Interventions
N=149 MMA embolization (middle meningeal artery embolization plus standard treatment).
N=161 standard treatment (standard nonoperative or surgical treatment alone).
Primary outcome
Rate of recurrent or residual chronic subdural hematoma, reoperation or surgical rescue, or major disabling stroke, MI, or death from neurologic causes within 180 days
16%
36%
36.0 %
27.0 %
18.0 %
9.0 %
0.0 %
MMA
embolization
Standard
treatment
Significant
decrease ▼
NNT = 5
Significant decrease in the rate of recurrent or residual chronic subdural hematoma, reoperation or surgical rescue, or major disabling stroke, MI, or death from neurologic causes within 180 days (16% vs. 36%; OR 0.36, 95% CI 0.2 to 0.66).
Secondary outcomes
No significant difference in death at day 180 (8% vs. 5%; AD 2.9%, 95% CI -2.9 to 9.3).
No significant difference in major disabling stroke at day 180 (1% vs. 1%; AD 0.2%, 95% CI -3.2 to 3.9).
Safety outcomes
No significant difference in death from any cause or major disabling stroke at day 30.
Conclusion
In patients with symptomatic chronic subdural hematoma, MMA embolization was superior to standard treatment with respect to the rate of recurrent or residual chronic subdural hematoma, reoperation or surgical rescue, or major disabling stroke, MI, or death from neurologic causes within 180 days.
Reference
David Fiorella, Stephen J Monteith, Ricardo Hanel et al. Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma. N Engl J Med. 2025 Feb 27;392(9):855-864.
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