AJNR. American journal of neuroradiology · 2026
Outcomes of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Chronic Kidney Disease: A Propensity Score Matched Cohort Study.
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Dakhel Sami, Essibayi Muhammed Amir, Azzam Ahmed Y, Salim Hamza Adel, Jamil Hasan, Chen Huanwen Alvin, Gandhi Dheeraj, Dmytriw Adam A, Yedavalli Vivek S, Colasurdo Marco, Malhotra Ajay, Altschul David J, Lakhani Dhairya A
Аннотация
INTRODUCTION: Middle meningeal artery embolization (MMAE) is increasingly used for chronic subdural hematoma (cSDH), but outcomes in patients with chronic kidney disease (CKD) remain poorly defined. Because CKD is associated with medical complexity and renal vulnerability, we evaluated whether CKD is associated with worse outcomes after MMAE and whether MMAE remains beneficial among patients with CKD.
METHODS: We performed a retrospective cohort study using the TriNetX US Collaborative Network. Adults with cSDH who underwent MMAE between January 1, 2016, and April 12, 2026, were identified using ICD-10-CM and ICD-10-PCS codes. Patients were stratified by baseline CKD status. Propensity-score matching was performed using 35 baseline characteristics, including demographics, comorbidities, cSDH subtype, concurrent procedures, antiplatelet exposure, hemodialysis, serum creatinine, estimated glomerular filtration rate, and blood urea nitrogen. Outcomes over 180 days included all-cause mortality, subsequent cSDH surgery, and acute kidney failure. A supplementary CKD-only analysis compared matched CKD patients treated with MMAE versus non-MMAE management.
RESULTS: Among 2,710 patients with cSDH treated with MMAE, 576 had CKD and 2,134 did not. After matching, 531 patients were included in each cohort. CKD was associated with higher 180-day mortality (17.9% vs 11.5%; HR, 1.55; 95% CI, 1.12-2.14; p = 0.007) and acute kidney failure (25.2% vs 8.9%; HR, 3.06; 95% CI, 2.20-4.27; p < 0.001), while subsequent cSDH surgery was similar (10.4% vs 10.9%; HR, 0.93; 95% CI, 0.64-1.35; p = 0.513). In the CKD-only matched analysis, MMAE was associated with lower subsequent cSDH surgery compared with non-MMAE management (10.1% vs 18.0%; HR, 0.53; 95% CI, 0.38-0.73; p < 0.001), similar acute kidney failure (26.3% vs 27.8%; HR, 0.93; 95% CI, 0.75-1.17; p = 0.547), and a trend toward lower mortality (18.7% vs 23.3%; HR, 0.78; 95% CI, 0.60-1.00; p = 0.052).
CONCLUSION: CKD was associated with higher mortality and acute kidney failure among cSDH patients undergoing MMAE, while subsequent cSDH surgery rates were similar to those of non-CKD patients. In the CKD-only analysis, MMAE was associated with lower subsequent cSDH surgery and similar acute kidney failure compared with non-MMAE management, supporting its feasibility in appropriately selected CKD patients.
METHODS: We performed a retrospective cohort study using the TriNetX US Collaborative Network. Adults with cSDH who underwent MMAE between January 1, 2016, and April 12, 2026, were identified using ICD-10-CM and ICD-10-PCS codes. Patients were stratified by baseline CKD status. Propensity-score matching was performed using 35 baseline characteristics, including demographics, comorbidities, cSDH subtype, concurrent procedures, antiplatelet exposure, hemodialysis, serum creatinine, estimated glomerular filtration rate, and blood urea nitrogen. Outcomes over 180 days included all-cause mortality, subsequent cSDH surgery, and acute kidney failure. A supplementary CKD-only analysis compared matched CKD patients treated with MMAE versus non-MMAE management.
RESULTS: Among 2,710 patients with cSDH treated with MMAE, 576 had CKD and 2,134 did not. After matching, 531 patients were included in each cohort. CKD was associated with higher 180-day mortality (17.9% vs 11.5%; HR, 1.55; 95% CI, 1.12-2.14; p = 0.007) and acute kidney failure (25.2% vs 8.9%; HR, 3.06; 95% CI, 2.20-4.27; p < 0.001), while subsequent cSDH surgery was similar (10.4% vs 10.9%; HR, 0.93; 95% CI, 0.64-1.35; p = 0.513). In the CKD-only matched analysis, MMAE was associated with lower subsequent cSDH surgery compared with non-MMAE management (10.1% vs 18.0%; HR, 0.53; 95% CI, 0.38-0.73; p < 0.001), similar acute kidney failure (26.3% vs 27.8%; HR, 0.93; 95% CI, 0.75-1.17; p = 0.547), and a trend toward lower mortality (18.7% vs 23.3%; HR, 0.78; 95% CI, 0.60-1.00; p = 0.052).
CONCLUSION: CKD was associated with higher mortality and acute kidney failure among cSDH patients undergoing MMAE, while subsequent cSDH surgery rates were similar to those of non-CKD patients. In the CKD-only analysis, MMAE was associated with lower subsequent cSDH surgery and similar acute kidney failure compared with non-MMAE management, supporting its feasibility in appropriately selected CKD patients.