MMA Embolization Tied to Lower 90-Day Mortality in Coagulopathic Chronic Subdural Hematoma

In coagulopathic chronic subdural hematoma, middle meningeal artery embolization associated with lower 90-day mortality vs medical management (18.8% vs 26.6%; HR 0.64) and as surgical adjunct (8.8% vs 20.3%; HR 0.40); rescue surgery no difference. Coagulopathy remained adverse.

• Among coagulopathic patients, MMA embolization added to surgery reduced 90-day mortality from 20.3% to 8.8% (HR 0.40; 95% CI 0.27–0.59; p<0.001).
• Standalone embolization vs medical management reduced mortality from 26.6% to 18.8% (HR 0.64; 95% CI 0.52–0.80; p<0.001).
• Rescue surgery rates did not significantly differ (p=0.22), and coagulopathy remained consistently associated with worse outcomes.

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