Bilateral Versus Unilateral Middle Meningeal Artery Embolization for Standalone Treatment of Unilateral Chronic Subdural Hematoma.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Gomez-Paz Santiago, Salem Mohamed M, Thind Sonam, Chahine Ahmad, Xu Jordan Curtis, Lang Michael J, Gross Bradley A, Siddiqui Adnan H, Levy Elad I, Riina Howard A, Howard Brian M, Khalessi Alexander, Dmytriw Adam A, Ortega Moreno Diego A, Cancelliere Nicole M, Pereira Vitor Mendes, Regenhardt Robert W, Smith William, Stapleton Christopher J, Patel Aman B, Matejka Matthias, Griessenauer Christoph J, Ogilvy Christopher S, Spiotta Alejandro M, Tonetti Daniel A, Khalife Jane, Srinivasan Visish M, Burkhardt Jan-Karl, Levitt Michael R, Tanweer Omar, Kass-Hout Tareq, Vargas Jan, Grandhi Ramesh
Аннотация
MATERIALS AND METHODS: This retrospective cohort included patients treated at 16 centers worldwide from 2018 through 2025. The primary endpoint was index-admission surgical rescue. The original 3:1 and confirmatory 1:1 propensity-matched analyses used prespecified baseline covariates. A composite sensitivity outcome of any retreatment was also examined post hoc.
RESULTS: Among 600 patients, 546 underwent unilateral and 54 bilateral MMAE. Bilateral cases had lower baseline radiographic severity and more often underwent general anesthesia and selective distal embolization. Index-admission surgical rescue occurred in 9.5% of unilateral and 0% of bilateral cases (p<0.001), with corresponding rates of 10.6% versus 0% after 3:1 matching (p<0.001) and 11.1% versus 0% after 1:1 matching (p<0.001). The post-hoc composite of any retreatment did not differ in the unmatched cohort (p=0.37), 3:1 cohort (p=0.56), or 1:1 cohort (>0.99). Other outcomes showed no statistically significant between-group differences, but postdischarge follow-up was incomplete.
CONCLUSIONS: Overall retreatment did not differ between groups, although bilateral MMAE was associated with fewer index-admission surgical rescues. These observational data identify, but do not validate, angiographically documented contralateral supply as a candidate selection marker for prospective evaluation but do not establish a benefit of bilateral treatment or support routine bilateral MMAE.