Middle Meningeal Artery Embolization Using a 4-Fr Diagnostic Catheter as a Guiding System via a Transradial Approach for Chronic Subdural Hematoma.

OBJECTIVE

Middle meningeal artery embolization (MMAE) has emerged as an effective minimally invasive treatment for chronic subdural hematoma (CSDH). Although the transradial approach (TRA) is increasingly used in neuroendovascular procedures, evidence regarding its feasibility for MMAE using a 4-Fr diagnostic catheter as a guiding system remains limited.

METHODS

This single-center retrospective study included 22 consecutive patients who underwent MMAE for CSDH between April 2023 and October 2025. Patients treated before October 2024 underwent transfemoral approach (TFA), whereas those treated thereafter underwent TRA following an institutional shift to a radial-first strategy. Procedural metrics, access-site complications, and functional outcomes were compared.

RESULTS

Thirteen patients underwent TRA and 9 underwent TFA. All procedures were technically successful. Compared with TFA, TRA was associated with significantly shorter procedure time (86 vs. 143 min, p = 0.003), reduced fluoroscopy time (44 vs. 112 min, p <0.001), and lower contrast volume (55 vs. 130 mL, p = 0.001). No access-site complications occurred in the TRA group, whereas 1 patient in the TFA group developed a fatal femoral-site infection.

CONCLUSION

MMAE using a 4-Fr diagnostic catheter as a guiding system is feasible and safe and was associated with favorable procedural efficiency in this series. The observed advantages likely reflect the guiding strategy and system configuration rather than an intrinsic superiority of a specific vascular access route and may be applicable across different access strategies in frail older patients with CSDH.