Hyperdense Capsule Sign on CT Predicts Benefit of Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma

In a post hoc analysis of MAGIC-MT trial (697 patients), the presence of hyperdense capsule sign on CT identified patients who benefited from MMA embolization for nonacute SDH: recurrence 5.0% vs 12.0% (P=.009) and serious AEs 5.9% vs 15.1% (P=.002). No benefit in HDCS-negative…

• Post hoc analysis of the prospective MAGIC-MT randomized trial (697 participants with nonacute SDH); 63.7% had a hyperdense capsule sign on noncontrast CT.
• In propensity-score matched analysis, MMA embolization reduced the primary outcome (symptomatic recurrence/progression) only in HDCS-positive patients (4.1% vs 11.2%, P=.04) and lowered serious adverse events; formal interaction test P=.01 for both outcomes.
• Post hoc, exploratory finding; not pre-specified. Requires prospective external validation before guiding clinical practice.

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