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SNIS 20th annual meeting electronic poster abstracts
E-096 Safety of proximal coil occlusion in MMA embolization: experience in 137 cases
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  1. B Meyer1,
  2. J Campos2,
  3. D Zarrin3,
  4. M Khan4,
  5. J Collard de Beaufort5,
  6. G Amin4,
  7. K Golshani2,
  8. N Beaty6,
  9. M Bender7,
  10. G Colby3,
  11. L Lin4,
  12. A Coon4
  1. 1University of Arizona College of Medicine, Tucson, Tucson, AZ, USA
  2. 2Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
  3. 3Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
  4. 4Carondelet Neurological Institute, St. Joseph’s Hospital, Tucson, AZ, USA
  5. 5Syracuse University, Syracuse, NY, USA
  6. 6Florida State University, Tallahassee Memorial Hospital, Tallahassee, FL, USA
  7. 7Department of Neurosurgery, University of Rochester, Rochester, NY, USA

Abstract

Introduction/Purpose Endovascular embolization of the middle meningeal artery (MMA) has emerged as an efficacious adjunctive and stand-alone modality for the management of chronic subdural hematomas (cSDH). The optimal combination of embolic materials and techniques remains unknown. Liquid embolization of the proximal MMA may risk disruption of non-target skull-base collaterals, yet simultaneously offer the potential for improved cSDH devascularization given the collateralized nature of the MMA. We report here our initial experience with the safety of utilizing proximal MMA coil embolization to augment cSDH devascularization in MMA embolization.

Materials and Methods Consecutive cases of MMA embolization with adjunctive proximal MMA coiling were retrospectively identified from a prospectively maintained IRB-approved database of the senior authors. Patient demographics, procedural details, cSDH characteristics, and periprocedural events were analyzed.

Results A total of 89 patients undergoing 137 consecutive MMA embolization procedures (mean age 74 ± 12 years, 52% females) over a 32-month study period (June 2020 to February 2023) were included. Patients presented after trauma or fall (72%, n=64), with headache (12%, n=17), altered mentation (14%, n=19), or miscellaneous symptoms; with history of anticoagulant use (11%, n=15), aspirin (27%, n=37) or other antiplatelet medication (32%, n=44). On presentation, average cSDH thickness was 10 ± 1.7 mm wide and a midline shift of 2 ± 0.3 mm, where 49% (n=67) were recurrent cSDHs with history of prior burr hole evacuation (30%, n=20), craniotomy (16%, n=11) or conservative management (54%). Forty-eight patients (54%) underwent bilateral embolizations (54%), for 74 left-sided cSDH (54%) and 63 right-sided cSDH (46%). The proximal anterior MMA branch was embolized in 16 (12%), posterior in 16 (12%), and both in 101 (74%) cases. Glue was used in 78 (57%), glue 10:1 dilution in 46 (36%), and onyx in 8 (5.8%) cases. The proximal coiling technique was successfully carried out in 137 (100%) cases, and no cases required periprocedural rescue surgery. One patient with history of end-stage renal disease and prior burr holes underwent embolization and 50 days later presented with symptomatic recurrence necessitating craniotomy for evacuation.

Conclusion Coil embolization occlusion of the proximal MMA may enhance efficacy of the MMA embolization procedure without significantly increasing procedural risk, including the risk of non-target embolization to skull base collaterals. Additional comparative studies are warranted.

Abstract E-096 Figure 1
Abstract E-096 Figure 1

(A) Ophthalmic (black) and skull-base temporal (white) collateral vessels off the anterior and posterior MMA branches, respectively. (B) Proximal coiling to avoid liquid embolic near collaterals

Disclosures B. Meyer: None. J. Campos: None. D. Zarrin: None. M. Khan: None. J. Collard de Beaufort: None. G. Amin: None. K. Golshani: None. N. Beaty: 2; C; Medtronic Neurovascular, Stryker Neurovascular. 5; C; CMO of NeuroMedica. M. Bender: 2; C; Stryker Neurovascular. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. L. Lin: 2; C; Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo, Rapid Medical, Balt. A. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Rapid Medical, Avail MedSystems, Imperative Care, InNeuroCo, Q’apel, Sequent Medical.

https://doi.org/10.1136/jnis-2023-SNIS.196

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