Material Matters: A Systematic Review and Meta-Analysis of the Effectiveness of Different Embolic Agents in Middle Meningeal Artery Embolization.

PURPOSE: To compare the effectiveness and safety of different embolizing agents used in middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematoma.

MATERIALS AND

METHODS

A literature search of PubMed, Cochrane Library, Scopus, and Google Scholar (up to 2024) included studies reporting MMAE outcomes for chronic subdural hematoma (cSDH). Study quality was evaluated using the Joanna Briggs Institute and Risk of Bias 2 (RoB 2) tools. Pooled data were analyzed with random-effects models, with heterogeneity assessed via the I2 statistic. Statistical significance was set at P < .05.

RESULTS

Of 997 articles screened, 33 studies (2013-2024) with 1,818 patients (mean age, 74.2 years [SD ± 11]; median follow-up, 3 months) were included. The pooled recurrence rate after MMAE was 0.07 (95% confidence interval, 0.05-0.10). By embolic agent, recurrence rates were the following: (a) polyvinyl alcohol (PVA), 0.07; (b) n-butyl cyanoacrylate (nBCA), 0.05; and (c) ethylene vinyl alcohol copolymer (EVOH), 0.07. Periprocedural complication rates were low: PVA, 0.02; nBCA, 0.01; EVOH, 0.00; and overall rate, 0.01. Favorable clinical and radiologic outcomes were observed in 81% and 84% of cases, respectively.

CONCLUSIONS

MMAE is effective for cSDH, offering low recurrence and complication rates with favorable clinical and radiologic outcomes. All embolic agents demonstrated promising effectiveness and safety profiles.