Abstract 047: Middle meningeal artery embolization with coils: Systematic review and meta‐analysis

IntroductionMiddle meningeal artery embolization (MMAe) is increasingly utilized as a primary or secondary treatment for chronic subdural hematoma (cSDH) and is usually performed with liquid embolics. Outcomes after MMAe with coiling as a standalone treatment or an adjunct to liquid embolics have not been reviewed.MethodsA systematic review of the literature was performed to identify all original research that included coiling for MMAe with or without liquid embolics. Studies using particles were excluded. The primary outcome was need for rescue treatment defined as any unplanned reintervention for recurrent or residual cSDH. Baseline clinical data was summarized with weighted means. Pooled outcomes were generated using random effects models.ResultsA total of 5 studies comprising 264 patients (mean age 73.9 years, 26% female) who underwent MMAe with coils were included. Nearly half of patients (49.7%) were on antiplatelet medications, a minority (15.5%) were on anticoagulants, and 23.1% had surgery prior to embolization. In 105 patients (39.8%) embolization was performed with coils alone while the remainder had adjunctive embolization with liquid embolics. The mean follow‐up duration was 145 days (range: 47 ‐ 180). The pooled rate of rescue treatment after embolization was 7.6% (95% CI 4.3 ‐ 13.2, I2 = 0%) and there was no publication bias based on Egger's regression test (p = 0.07). In the subgroup analysis of 3 studies that only included MMA embolization with standalone coiling the pooled rate of rescue treatment was 8.5% (95% CI 4.1 ‐ 16.9, I2 = 0%). Only 2 patients (0.8%) experienced complications related to the embolization, and neither of these were related to coiling.ConclusionMMAe with coils is potentially safe and effective. As a standalone treatment coiling appears to have low retreatment rates, but additional large scale studies are needed.