Journal article
Multi-pedicle versus single-pedicle middle meningeal artery embolization for nonacute subdural hematoma
Neuroradiology
09/21/2026
DOI: 10.1007/s00234-026-04187-2
PMID: 42766032
Abstract
Nonacute subdural hematomas (nSDH) are common yet serious extra-axial hemorrhages that result in significant morbidity and mortality. Middle meningeal artery (MMA) embolization (MMAE) is a recent endovascular treatment that involves occlusion of the MMA, inducing hemostasis in and around the hematoma. While many aspects of MMAE have been explored, there is currently limited data on the optimal extent of embolization.
To determine whether single or multiple pedicle embolization of the MMA is superior in inducing hemostasis in nSDH.
We compared single versus multi pedicle embolization by a retrospective multicenter analysis of nSDH patients who underwent MMAE between 2019 and 2024 at participating centers in the MESH (MMA Embolization for Subdural Hematoma) Registry. 679 patients who received a liquid embolic agent with branch-level embolization data were included.
While multi-pedicle embolization hastened nSDH thinning at 1 month (5.7 vs. 3.3 mm reduction; difference 2.4 mm, 95% CI 1.0-3.8; P = .002), by 3 months thickness reduction had converged between groups (8.2 vs. 8.4 mm; P = .91). Among 679 patients (456 multi-pedicle, 223 single-pedicle), favorable functional outcome (mRS 0-2) was more frequent with multi-pedicle embolization (53.5% vs. 43.0%; adjusted OR 1.81, 95% CI 1.26-2.60; P = .001), whereas recurrence, rescue surgery, and treatment failure did not differ.
Future, multi-center randomized prospective trials are warranted to address confounding variables that limit this observational study. Follow-up beyond 3 months was limited, so durability is unknown.
Details
- Title: Subtitle
- Multi-pedicle versus single-pedicle middle meningeal artery embolization for nonacute subdural hematoma
- Creators
- Garrett W Thrash - University of Alabama at BirminghamBluyé DeMessie - Albert Einstein College of MedicineElijah L Wang - University of Alabama at BirminghamJesse G Jones - University of Alabama at BirminghamMuhammed Amir Essibayi - Albert Einstein College of MedicineHamza Adel Salim - The University of Texas MD Anderson Cancer CenterAlireza Karandish - Albert Einstein College of MedicineDeepak Khatri - Albert Einstein College of MedicineNeil Haranhalli - Montefiore Medical CenterAmanda Baker - Albert Einstein College of MedicineRichard Zampolin - Albert Einstein College of MedicineAllan L Brook - Montefiore Medical CenterSeon-Kyu Lee - Albert Einstein College of MedicineNimer Adeeb - Louisiana State University in ShreveportDhairya A Lakhani - West Virginia UniversityYan-Lin Li - University of OxfordDavide Simonato - University of OxfordDiego Alejandro Ortega - University of TorontoNicole Cancelliere - University of TorontoJose Danilo Diestro - University of TorontoJoseph Carnevale - New York Hospital QueensCraig Schreiber - NewYork–Presbyterian HospitalAtakan Orscelik - Mayo ClinicZachary Abecassis - University of WashingtonSpencer Raub - University of WashingtonGeorgios S Sioutas - Hospital of the University of PennsylvaniaAbdulrhman Alsalama - University of Illinois ChicagoClairice Pearce - University of Illinois ChicagoGiancarlo Salsano - Ospedale Policlinico San MartinoRahim Abo Kasem - Medical University of South CarolinaSvetlana Kvint - NYU Langone HealthAndrew Falzon - St George’s University Hospitals NHS Foundation TrustVance Cantrell - Lehigh Valley Health NetworkBrian Holliday - Lehigh Valley Health NetworkJefferson O Abaricia - Oregon Health & Science UniversityPedram D Maleknia - Baylor College of MedicineLeonardo Cruz-Criollo - University of IowaSamantha Schimmel - University of South FloridaBasel Musmar - Thomas Jefferson UniversityMatthew Alexander - Sutter Medical CenterJorge Rios Zermeno - Mayo ClinicPrateeka Koul - Geisinger Wyoming Valley Medical CenterAhmed Aljuboori - Geisinger Wyoming Valley Medical CenterDominik F Vollherbst - University Hospital HeidelbergDomagoj Gajski - Sisters of Charity HospitalJared Cooper - Westchester Medical CenterOmar Alwakaa - Beth Israel Deaconess Medical CenterMohamad EzzeldinJames Grist - University of OxfordFulvio Zaccagna - University of OxfordChristopher S Ogilvy - Beth Israel Deaconess Medical CenterFawaz Al-Mufti - Westchester Medical CenterVladimir Kalousek - Sisters of Charity HospitalMarkus A Möhlenbruch - University Hospital HeidelbergLuca Scarcia - Hôpitaux Universitaires Henri-MondorWilliam W Wroe - The University of Texas Health Science Center at HoustonHussein A Zeineddine - The University of Texas Health Science Center at HoustonSi Zhao Tang - National University of SingaporePeter B Sporns - University Hospital of BaselAnil Gopinathan - National University HospitalRobert W Regenhardt - The University of Texas Health Science Center at HoustonSpiros L Blackburn - The University of Texas Health Science Center at HoustonClemens M Schirmer - Geisinger Wyoming Valley Medical CenterThien Huynh - Mayo Clinic in FloridaRabih G Tawk - Mayo Clinic in FloridaFabio Settecase - Sutter HealthStavropoula Tjoumakaris - Thomas Jefferson UniversityPascal Jabbour - Thomas Jefferson UniversityKunal Vakharia - University of South FloridaMario Zanaty - University of IowaSantiago Ortega-Gutierrez - University of IowaMarco Colasurdo - Oregon Health & Science UniversityHussein H Nasser - Lehigh Valley Health NetworkSri Hari Sundararajan - Lehigh Valley Health NetworkPascal J Mosimann - Toronto Western HospitalErez Nossek - NYU Langone HealthEytan Raz - NYU Langone HealthSami Al Kasab - Medical University of South CarolinaAlejandro M Spiotta - Medical University of South CarolinaLucio Castellan - Ospedale Policlinico San MartinoBruno Del Sette - Ospedale Policlinico San MartinoAli Alaraj - University of Illinois ChicagoCaterina Michelozzi - IRCCS Ospedale San RaffaeleDavide Saraceno - IRCCS Ospedale San RaffaelePietro Panni - IRCCS Ospedale San RaffaeleVisish M Srinivasan - Hospital of the University of PennsylvaniaJan-Karl Burkhardt - Hospital of the University of PennsylvaniaGaultier Marnat - Centre Hospitalier Universitaire de BordeauxPietro Mario Santini - Centre Hospitalier Universitaire de BordeauxMichael R Levitt - University of WashingtonGiuseppe Lanzino - Mayo ClinicWaleed Brinjikji - Mayo ClinicJared Knopman - NewYork–Presbyterian HospitalTareq Kass-Hout - University of ChicagoJulian Spears - University of TorontoThomas Marotta - University of TorontoVitor Mendes Pereira - University of TorontoMaurizio Fuschi - University of OxfordTufail Patankar - Barking, Havering And Redbridge University Hospitals NHS TrustDavid J Altschul - Montefiore Medical CenterAdam A Dmytriw - University of Toronto
- Resource Type
- Journal article
- Publication Details
- Neuroradiology
- DOI
- 10.1007/s00234-026-04187-2
- PMID
- 42766032
- NLM abbreviation
- Neuroradiology
- ISSN
- 0028-3940
- eISSN
- 1432-1920
- Publisher
- Springer Nature
- Language
- English
- Electronic publication date
- 09/21/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985236420202771
Metrics
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