Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025
Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Gomez-Paz Santiago, Salem Mohamed M, Baker Cordell, Kuybu Okkes, Sioutas Georgios S, Carroll Kate T, Salih Mira, Dmytriw Adam A, Khalife Jane, Smith William, Moreno Diego Alejandro Ortega, Regenhardt Robert W, Cancelliere Nicole M, Spiotta Alejandro M, Tanweer Omar, Stapleton Christopher J, Lang Michael, Pereira Vitor M, Patel Aman B, Siddiqui Adnan H, Levy Elad I, Ogilvy Christopher S, Tonetti Daniel, Thomas Ajith J, Srinivasan Visish M, Jankowitz Brian T, Levitt Michael R, Gross Bradley A, Burkhardt Jan-Karl, Grandhi Ramesh
Аннотация
BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, p = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43-3.51, p < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25-0.69, p = 0.001) to be independent at last follow-up.ConclusionThis study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.