Middle meningeal artery embolization with SwiftPAC coils for the treatment of chronic subdural hematomas

Objective Middle meningeal artery embolization (MMAE) has been shown to lower recurrence and reoperation rates of chronic subdural hematomas (cSDHs). The purpose of this study is to demonstrate the initial use, safety, and effectiveness of SwiftPAC (Penumbra Inc., Alameda, CA, USA) coils for MMAE. Methods This is a retrospective study of consecutive MMAE performed with SwiftPAC coils for in patients with cSDHs. Liquid or particle embolization was excluded. Selection criteria for adjunct versus stand-alone MMAE were based on clinical judgement. Outcome measures included were a decrease in size of the cSDH, decreased size >50%, midline shift, reoccurrence or progression, retreatment, clinical stability or symptom improvement, and procedure-related complications. Results Twenty-three patients/31 hemispheres received MMAEs (eight bilateral and 15 unilateral) with SwiftPAC coils. Twenty-two patients (96%) had clinical and radiographic follow-up (median 54 days), and one patient was lost to follow-up. Sixteen (69.6%) MMAEs were performed as an adjunct to surgical drainage; seven (30.4%) were stand-alone MMAEs. No procedural-related complications were observed. Clinical stability or symptom improvement at follow-up was demonstrated in 95.4% of patients (21/22). Radiographic improvement at follow-up was demonstrated in 93.3% (28/30). Nineteen (63.3%) cSDHs had a decrease in size >50% and nine cSDHs (30%) demonstrated complete resolution. One patient required retreatment for recurrence. Conclusions MMAE with SwiftPAC coils can be performed with a high safety profile and good radiographic and clinical outcomes. Given the small size and no comparison cohort, further research is warranted.