Angiographic 'paradoxical predominance' sign predicts extra collateral supply to chronic subdural hematoma

In chronic subdural hematoma, a contralateral middle meningeal artery (MMA) larger than the ipsilateral by ≥0.2 mm predicted additional collaterals: 93.75% vs 35.78% (p<0.001). Ipsilateral MMA ≤1.384 mm also predicted collaterals (p<0.001).

• Retrospective analysis of 125 patients with chronic subdural hematoma undergoing middle meningeal artery embolization.
• Paradoxical predominance sign (contralateral MMA ≥0.2 mm larger than ipsilateral) was identified in 16 patients (12.8%).
• Recurrence and hematoma resorption were comparable after collateral embolization, suggesting successful embolization of identified collaterals neutralized the risk.

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