Trends in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Treatment

Introduction Chronic subdural hematoma (cSDH) is associated with considerable morbidity and mortality. cSDH Patients are often treated by conventional surgical drainage (CSD). In recent years, middle meningeal artery embolization (MMAE) has emerged as a crucial adjunct to surgical drainage or stand‐alone therapy to reduce recurrence risk. This study aims to describe the trends and underlying predictive factors in MMAE use in interventional procedures among patients with an incident diagnosis of cSDH within one year of diagnosis. Methods Using an administrative claims database of individuals with commercial insurance in the US, Optum Clinformatics Date of Death (DOD) Data Mart, adult patients (aged ≥18 years) having an incident diagnosis of cSDH from 2017 to 2023 were identified. MMAE use in the one‐year period post‐cSDH diagnosis period was examined. Kendall's tau tests were conducted to assess the year‐wise trend in the rate of MMAE procedures. A logistic regression model was used to evaluate the predictive factors for MMAE receipt. Results Based on study inclusion and exclusion criteria, 48,408 patients were identified. A significant increasing trend in the rate of MMAE procedures was observed during the study period from 0.1% in 2017 cohort to 6.4% in 2023 cohort (Kendall's tau test [τ]=1.00, p =0.003). This trend reflected both an increase in MMAE alone (0.05% in 2017 to 3.12% in 2023, Kendall's tau test [τ]=0.905, p =0.007) and MMAE in combination with conventional surgical drainage (0.03% in 2017 to 2.31% in 2023, Kendall's tau test [τ]=1.00, p =0.003). The increasing trend in MMAE use was consistent across patients with different sex, race, and comorbidity severity. Older age (60‐69 years vs 18‐59 years: odds ratio [OR] 1.51, 95% confidence interval [CI] 1.14‐2.01; 70‐79 years vs 18‐59 years: OR 1.71, 95% CI 1.32‐2.22), female sex (vs male: OR 2.12, 95% CI 1.88‐2.40), non‐White race/ethnicity (Black vs White: OR 1.42, 95% CI 1.20‐1.69; Asian vs White: OR 1.62, 95% CI: 1.27‐2.07; Hispanic vs White: OR 1.36, 95% CI 1.15‐1.61), and a prior history of stroke/transient ischemic attack (TIA) (vs no prior history of stroke/TIA: OR 1.30, 95% CI 1.15‐1.46) were predictive of significantly higher likelihood of undergoing MMAE procedures. However, patients with a prior history of acute myocardial infarction (yes vs no: OR 0.58, 95% CI 0.44‐0.78) were significantly less likely to undergo MMAE procedures post‐cSDH diagnosis. Conclusions Among commercially insured patients diagnosed with cSDH, an increasing trend in the rates of MMAE intervention was observed during our study period. Patient demographics and comorbidities were found to be predictive of the likelihood of receiving MMAE. Study results highlight the increasing adoption of MMAE, minimally invasive embolization, for adjunctive cSDH treatment.