Abstract 113: Transradial Versus Transfemoral approach in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Background Chronic subdural hematoma (cSDH) is an important clinical entity with increasing incidence, especially in the elderly population. The conventional management of cSDH with burr hole surgery and drainage is associated with a high recurrence rate that is estimated to be up to 30%. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive therapy to reduce recurrence rates. Transfemoral access (TFA) is the conventional route for neuroendovascular procedures, but transradial access (TRA) offers potential advantages, including reduced access‐site complications, earlier ambulation, and shorter hospital stays. Objective The aim of our systematic review and meta‐analysis is to compare the safety and efficacy of TRA versus TFA for MMAE in cSDH patients. Methods This study followed Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines and involved a comprehensive search of four databases to identify studies comparing TRA and TFA in MMAE. Outcomes included hematoma recurrence, hospital length of stay, procedural duration, access‐site complications, and overall complications. Results Four studies met the inclusion criteria. There were no significant differences between TRA and TFA in hematoma recurrence (Relative Risk (1) 0.65, 95% Confidence Interval CI 0.09‐4.85), hospital length of stay (Mean Difference MD 0.10 days, 95% CI ‐0.11‐0.31), procedural duration (MD 0.04 hours, 95% CI ‐0.49‐0.56), access‐site complications (RR 0.24, 95% CI 0.04‐1.40), or overall complications (RR 0.76, 95% CI 0.33‐1.75). Conclusion TRA demonstrates comparable safety and efficacy to TFA for MMAE in cSDH patients. Although current evidence is limited to observational studies, these findings support the feasibility of TRA as an access route. Future large‐scale studies are necessary to validate these results and optimize procedural strategies. image