Standalone Coils for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma Treatment

Introduction Chronic subdural hematoma (cSDH) has an incidence of 8.2‐14.0 per 100,000 individuals, predominantly affecting the elderly. The use of middle meningeal artery embolization (MMAe) as an adjunct to surgical evacuation has recently picked up pace with recent trials showing reduced recurrence rate of cSDH. Although several embolization techniques (liquid embolics, coils, particles etc.) are available, the optimal one for MMAe remains under investigation. Objective To evaluate the technical success, safety, and short‐term outcomes of using standalone coils for MMAe in patients with cSDH at a single tertiary care center. Methods All patients with SDH who underwent MMAe with coils at Corewell Health West between June 2023 and June 2025 were retrospectively studied. Baseline data including demographics, imaging characteristics and procedural details were collected. Clinical outcomes at 1‐4 weeks, 6‐12 weeks, and 4‐6 months as well as radiological resolution of cSDH were also evaluated. Results A total of 77 patients and 101 technically successful embolizations were studied. Bilateral MMAe was performed in 31.2% of cases with a mean fluoroscopy time of 23.8 minutes. 89.6% of the cases were performed under conscious sedation and 77.9% of procedures completed with radial access. 72.3% of cases underwent surgical drainage of cSDH in conjunction with MMAe. 46.6% of cases showed resolution or improvement at 1‐4 weeks, 69.3% of cases showed resolution or improvement at 6‐12 weeks and 95.1% of cases showed resolution or improvement at 4‐6 months. 50% of the cases had coil embolization of the distal third, while 34.6% had coil embolization of the middle third of the MMA. All patients had coil embolization of the proximal third of the MMA down to the foramen spinosum. Complete or near complete resolution was more commonly seen in patients with coil embolization of the distal third, as compared to the middle third of the MMA. 4% of the patients required subsequent unplanned surgical intervention. No major procedural complications were observed. Conclusion Standalone coils for MMAe for treatment of cSDH demonstrated high technical success, low fluoroscopy time, no major complications and favorable short‐term safety outcomes. Distal embolization of MMA was associated with higher rates of hematoma resolution. Further studies with longer follow up are warranted to determine long term outcomes and complications associated with standalone coil use for MMAe.