O-050 Polyvinyl alcohol particle size in middle meningeal artery embolization for chronic subdural hematomas

Abstract

<h3>Introduction</h3> Optimal treatment for chronic subdural hematomas remains controversial and perioperative risks and comorbidities may affect management strategies. Minimally invasive procedures, including middle meningeal artery (MMA) embolization are emerging as alternatives to the standard operative treatments. The optimal techniques and embolic material used for embolization is not well elucidated. <h3>Methods</h3> We performed a retrospective review of all patients undergoing MMA embolization at our institution and compared patients who underwent embolization with polyvinyl alcohol (PVA) particles in two different size. Patients undergoing embolization with 45–150 micron particles were compared to those undergoing embolization with 150–250 micron particles. Primary outcome measures were subdural hematoma recurrence as defined by need for further intervention. Secondary outcomes included readmission rate, complications, and membrane penetration of particles during embolization. <h3>Results</h3> 107 total patients underwent MMA embolization. 73 (68.2%) underwent embolization with 45–150 micron PVA particles and 34 (31/8%) with 150–250 micron PVA particles. Patients in the 45–150 micron cohort had higher rates of distal membrane penetration (91.8% vs. 73.5%; p&lt;0.05) as noted by angiography. Operative and in-hospital complication rates were similar between the cohorts. 30-day Readmission rates were higher in the 150–250 micron cohort, although this was not significant (26.4% vs. 16.4%). Recurrence rates were significantly higher in the 150–250 micron cohort (20.6% vs. 9.6%; p&lt;0.05). <h3>Conclusion</h3> Smaller PVA particle size at 45–150 microns results in better distal penetration and decreased recurrence or operative intervention in chronic subdural hematoma patients undergoing MMA embolization. Further randomized studies are warranted to delineate this effect. <h3>Disclosures</h3> <b>E. Dowlati:</b> None. <b>M. Rock:</b> None. <b>D. Felbaum:</b> None.