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SNIS 20th annual meeting electronic poster abstracts
E-183 Middle meningeal artery embolization in patients with coagulopathy
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  1. W Salah1,
  2. M Findlay2,
  3. J Scoville1,
  4. C Baker1,
  5. C Ogilvy3,
  6. J Moore3,
  7. H Riina4,
  8. E Levy5,
  9. A Siddiqui5,
  10. A Spiotta6,
  11. C Cawley7,
  12. A Khalessi8,
  13. O Tanweer9,
  14. R Hanel10,
  15. B Gross11,
  16. O Kuybu12,
  17. A Nguyen Hoang13,
  18. A Baig5,
  19. M Khorasanizadeh14,
  20. A Mendez15,
  21. G Cortez10,
  22. J Davies16,
  23. S Narayanan17,
  24. B Howard7,
  25. M Lang11,
  26. A Thomas18,
  27. J Khalifeh18,
  28. T Jovin18,
  29. G Sioutas19,
  30. K Carroll20,
  31. Z Abecassis20,
  32. J Rodriguez20,
  33. B Jankowitz19,
  34. M Levitt21,
  35. P Khan22,
  36. J Bukhardt19,
  37. M Salem19,
  38. R Grandhi1
  1. 1Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA
  2. 2School of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
  3. 3Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
  4. 4Neurosurgery, NYU Langone Medical Center, New York, NY, USA
  5. 5Neurosurgery, Jacob School of Medicine at Buffalo University, Buffalo, NY, USA
  6. 6Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
  7. 7Neurosurgery, Emory University, Atlanta, GA, USA
  8. 8Neurosurgery, University of California San Diego, La Jolla, CA, USA
  9. 9Neurosurgery, Baylor College of Medicine, Houston, TX, USA
  10. 10Neurosurgery, Lyerly Neurosurgery Baptist Neurological Institute, Jacksonville, FL, USA
  11. 11Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
  12. 12Neurology, University of Utah School of Medicine, Pittsburgh, PA, USA
  13. 13Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
  14. 14Neurosurgery, Mount Sinai, New York, NY, USA
  15. 15Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  16. 16Neurosurgery, Jacobs School of Medicine, Buffalo, NY, USA
  17. 17Neurosurgery, Pacific Neuroscience Institute, Burbank, CA, USA
  18. 18Neurosurgery, Cooper University Health Care, Camden, NJ, USA
  19. 19Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  20. 20Neurosurgery, University of Washington, Seattle, WA, USA
  21. 21Department of Neurosurgery, University of Washington, Seattle, WA, USA
  22. 22Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA

Abstract

Middle meningeal artery embolization (MMAE) is emerging as a safe and effective surgical adjunct or stand-alone treatment for chronic subdural hematomas (cSDH). However, the risk of cSDH recurrence following MMAE is not negligible. To better define which patients are at risk of recurrence, we performed a multi-institutional retrospective analysis to characterize the impact of preoperative coagulopathy on patient outcomes.

Patients that underwent MMAE between 2019 and 2023 were separated by coagulopathy status. Coagulopathy was defined as use of anticoagulation, antiplatelet agents, or thrombocytopenia (platelets <100,000). Demographics, preoperative characteristics, procedural details, and in-hospital events were captured. Radiographic and outcomes data were collected at 90-days post MMAE. Patients with coagulopathy were stratified by no risk, low risk (aspirin 81mg or platelets <100k) and high risk (use of anticoagulation, aspirin 325mg, ticagrelor, or clopidogrel). Univariate and multivariate analyses were performed. Propensity-score matching was then conducted based on presence of coagulopathy with matching covariates adjusting for known cSDH risk factors. All analyses were repeated. 866 unmatched patients and 516 matched patients were analyzed. On both matched and unmatched analysis, patients with coagulopathy were found to have statistically significant longer hospital stays and higher likelihoods of surgical intervention for cSDH evacuation following MMAE (table 1). On further analysis, increased risk of surgical intervention remained significant for patients on anticoagulation but did not hold true for those on antiplatelet agents or those with thrombocytopenia (table 2). Patients in the high-risk group were found to be 2.80 times more likely to require later surgical intervention on matched and 2.1 times on unmatched analysis (table 3). Those with preoperative thrombocytopenia were found to have 6.19 higher likelihood of in hospital mortality. Those in the high-risk group that underwent stand-alone MMAE had an odds ratio of 2.82 for MMAE failure requiring later surgery. Those in the high-risk group that had MMAE as an adjunct to initial surgery were not observed to have a statistically significant difference in recurrence risk. Performing MMAE in patients with coagulopathy may incur increased risk of requiring surgical intervention for chronic subdural hemorrhage evacuation, particularly in patients presenting with use of anticoagulation, ticagrelor, and clopidogrel.

View this table:
Abstract E-183 Table 1

Unmatched/matched multivariate analysis for SDH retreatment, in-hospital mortality and mRS

View this table:
Abstract E-183 Table 2

Unmatched/matched multivariate analysis of subcomponents: retreatment, mortality and mRS

View this table:
Abstract E-183 Table 3

Unmatched and matched analysis of SDH retreatment risk per coagulopathy severity

Disclosures W. Salah: None. M. Findlay: None. J. Scoville: None. C. Baker: None. C. Ogilvy: None. J. Moore: None. H. Riina: None. E. Levy: None. A. Siddiqui: None. A. Spiotta: None. C. Cawley: None. A. Khalessi: None. O. Tanweer: None. R. Hanel: None. B. Gross: None. O. Kuybu: None. A. Nguyen Hoang: None. A. Baig: None. M. Khorasanizadeh: None. A. Mendez: None. G. Cortez: None. J. Davies: None. S. Narayanan: None. B. Howard: None. M. Lang: None. A. Thomas: None. J. Khalifeh: None. T. Jovin: None. G. Sioutas: None. K. Carroll: None. Z. Abecassis: None. J. Rodriguez: None. B. Jankowitz: None. M. Levitt: None. P. Khan: None. J. Bukhardt: None. M. Salem: None. R. Grandhi: None.

https://doi.org/10.1136/jnis-2023-SNIS.282

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