Abstract TMP93: Middle Meningeal Artery Embolization - A Preliminary Analysis Of Efficacy In Acute Settings And Among Patients With Major Co-morbidities

Abstract

Introduction: Middle meningeal artery (MMA) embolization is an therapy utilized in the management of subdural hematomas (SDH). Based on promising preliminary data, several clinical trials are underway to evaluate the efficacy of this endovascular approach in patients with chronic subdural hematomas. However, consensus for the efficacy of MMA embolization has not been well established in acute settings or among patients with major co-morbidities. Methods: Patient data were gathered from consecutive cases performed at UCLA between 05/02/2018 and 08/26/2022. Retrospective chart review was performed to determine inpatient/outpatient status, mortality, co-morbidities, and time-to-death. Primary statistical analyses were performed to determine the proportion of patients. Results: Among the 111 patients meeting study entry criteria, 44 (39.6%) had acute, inpatient MMA procedures performed and 66 (40.4%) had elective procedures in the setting of advanced or terminal diseases (e.g. malignancy, cirrhosis). After follow-up of median 31.9 months, mean 17.4 months years, 86 (77.5%) of patients were still living and 25 (22.5%) were deceased. The age for both deceased and living patients was the same, 71±13 vs 71±16.1 years old. Mortality during follow-up was more common among patients undergoing MMA as an inpatient (47.8% vs 6.1%). Among the 25 deceased patients, mortality occurred within 1 year in 64% and beyond 1 year in 36%. Co-morbidity frequencies among deceased compared with surviving patients were: 40% vs 22%; solid tumor cancer in 28% vs 14%; cirrhosis in 32% vs 6%; and hematologic malignancy in 4% vs 4%. Among those deceased, 14 of 25 (56%) were diagnosed with a major co-morbidity (hematologic condition, cancer, or liver cirrhosis) at the time of the procedure. Among those living, 19 of 86 (22.1%) were diagnosed with a major co-morbidity (hematologic condition, cancer, or liver cirrhosis) at the time of the procedure. Conclusion: Patients with SDH undergoing MMA embolization on an acute inpatient basis have a high, nearly 50%, rate of mortality within the next 0.5-2 years, while patients electively treated despite major co-morbidities have a substantially higher survival rate.