Core Concepts
Embolization procedures significantly reduce the need for surgery in patients with subdural hematomas, offering a breakthrough treatment option.
Abstract
The treatment of subdural hematomas has seen a significant advancement with the introduction of embolization procedures. Three randomized controlled trials, EMBOLISE, MAGIC-MT, and STEM, showcased the benefits of embolization in reducing the need for surgery and recurrence rates in patients with subdural hematomas. The trials utilized different embolization products, such as Onyx and Squid, to deliver the treatment. Embolization has emerged as a promising alternative to traditional surgical methods, offering improved outcomes and safety profiles for patients with subdural hematomas.
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EMBOLISE Trial:
- MMA embolization with the Onyx product led to a significant reduction in the need for repeat surgical drainage of subdural hematomas.
- The embolization group showed lower rates of hematoma recurrence/progression and neurologic deterioration compared to the control group.
- Safety outcomes were favorable with minimal serious adverse events related to the embolization procedure.
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MAGIC-MT Trial:
- The trial demonstrated that embolization was superior to usual care alone in reducing hematoma recurrence or progression.
- Functional outcomes were similar in embolization and control patients, with most patients showing good recovery.
- Serious adverse events were fewer in patients receiving embolization.
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STEM Trial:
- Embolization therapy significantly reduced treatment failure rates in patients with chronic subdural hematomas.
- The procedure was beneficial for both surgical and nonsurgical patient populations, offering a promising treatment option.
- Safety outcomes were comparable between the standard management and embolization groups.
Stats
"The primary endpoint was the rate of hematoma recurrence/progression requiring repeat surgical drainage within 90 days."
"This occurred in 4.1% of the embolization group vs 11.3% of the control group."
"Serious adverse events related to the embolization procedure occurred in 2% of patients."
"The primary outcome was symptomatic subdural hematoma recurrence or progression within 90 days."
"This occurred in 7.2% of the embolization group vs 12.2% of the control group."
"The primary endpoint occurred in 39.2% of the standard management groups vs 15.2% of the group who received standard management plus embolization therapy."
Quotes
"All these three trials are positive. They are essentially showing the same thing and provide strong class 1 level evidence that endovascular treatment for subdural hematoma is strongly beneficial." - Tudor Jovin, MD
"Essentially, we are gluing shut the artery that feeds the dura." - Jason Davies, MD
"These data show that this embolization procedure should enable many patients with subdural hematoma to avoid having surgery altogether." - Adam Arthur, MD