EMBOLISE randomized surgical trial for subdural hematoma: clinical benefits beyond reoperation with middle meningeal artery embolization.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Knopman Jared, Davies Jason M, Mokin Maxim, Hassan Ameer E, Harbaugh Robert E, Khalessi Alexander, Fiehler Jens, Levy Elad I, Gross Bradley A, Grandhi Ramesh, Tarpley Jason, Sivakumar Walavan, Bain Mark, Crowley R Webster, Link Thomas W, Fraser Justin F, Levitt Michael R, Chen Peng Roc, Hanel Ricardo A, Bernard Joe D, Jumaa Mouhammad, Youssef Patrick P, Cress Marshall C, Chaudry Mohammad Imran, Shakir Hakeem J, Lesley Walter S, Billingsley Joshua, Jones Jesse, Koch Matthew J, Paul Alexandra R, Mack William J, Osbun Joshua W, Dlouhy Kathleen M, Grossberg Jonathan A, Kellner Christopher P, Sahlein Daniel H, Santarelli Justin, Schirmer Clemens M, Mazaris Paul, Liu Jesse J, Majjhoo Aniel Q, Wolfe Thomas, Patel Neil V, Roark Christopher D, Siddiqui Adnan H, EMBOLISE Investigators
Аннотация
METHODS: Symptomatic subacute/chronic SDH patients were randomized to surgical evacuation alone (control) or surgical evacuation plus Onyx MMAe (treatment). Changes in modified Rankin Scale (mRS) scores, frequency of unscheduled follow-up visits, and radiographic evolution of hematomas in patients with versus without reoperation were analyzed.
RESULTS: A total of 197 patients were randomly assigned to the treatment group and 203 to the control group. Patients who required reoperation compared with those who did not exhibited a ~threefold higher incidence of mRS >2 (37.0% vs 12.9%, P=0.0025) and an ~2.5 fold increase in mRS worsening (22.2% vs 9.5%, P=0.0503) at 180 days. In patients who did not receive MMAe, there was a ~threefold fold increase in rate of SDH recurrence/progression even among those who did not require reoperation (14.3% vs 5.3%, P=0.0045) and a ~twofold increase in unscheduled physician follow-up visits (27.1% vs 14.7%, P=0.0031).
CONCLUSION: Among patients with symptomatic subacute/chronic SDH, reoperation was associated with increased rates of mRS worsening and higher mRS scores at follow-up. Adjunctive Onyx MMAe resulted in lower rates of hematoma recurrence/progression and fewer unscheduled physician follow-up visits. Thus, in addition to reducing surgical reoperation rates, adjunctive MMAe led to improved clinical outcomes and reduced healthcare encounters.