NYMC Faculty Publications

Middle Meningeal Artery Embolization for Subdural Hematoma: CT/MRI End Points of the EMBOLISE Trial

Helge Kniep, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Susanne Gellissen, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Matthias Bechstein, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Lukas Meyer, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Gabriel Broocks, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Christian Heitkamp, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Laurens Winkelmeier, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Fabian Flottmann, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Vincent Geest, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Uta Hanning, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Christian Thaler, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Maxim Bester, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Jason M. Davies, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
Jared Knopman, Department of Neurological Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.
Maxim Mokin, Department of Neurosurgery and Brain Repair, University of South Florida, and Tampa General Hospital, Tampa, Fla.
Ameer E. Hassan, Department of Neuroscience, Valley Baptist Medical Center, Harlingen, Tex.
Robert E. Harbaugh, Departments of Neurosurgery and Engineering Science and Mechanics, Penn State University, Hershey, Pa.
Alexander Khalessi, Departments of Neurological Surgery, Surgery, Radiology, and Neurosciences, University of California, San Diego, La Jolla, Calif.
Adnan H. Siddiqui, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
Bradley A. Gross, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Ramesh Grandhi, Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah.
Jason Tarpley, Department of Radiology, Providence Little Company of Mary Medical Center, Torrance, Calif.
Walavan Sivakumar, Department of Neurosurgery, Providence Little Company of Mary Medical Center, Torrance, and Pacific Neuroscience Institute, Santa Monica, Calif.
Mark Bain, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
R Webster Crowley, Department of Neurosurgery, Rush University, Chicago, Ill.
Thomas W. Link, Department of Neurosurgery, North Shore University Hospital at Northwell Health, Great Neck, NY.
Justin F. Fraser, Department of Neurological Surgery, Neurology, Radiology, Otolaryngology, and Neuroscience, University of Kentucky, Lexington, Ky.
Michael R. Levitt, Departments of Neurological Surgery, Radiology, Neurology, and Mechanical Engineering, Stroke and Applied Neuroscience Center, University of Washington, Seattle, Wash.
Peng Roc Chen, Department of Neurosurgery, Memorial Hermann-Texas Medical Center, Houston, Tex.
Ricardo A. Hanel, Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Fla.
Joe D. Bernard, Department of Neurosurgery, Atrium Health Carolinas Medical Center, and Carolina Neurosurgery and Spine Associates, Charlotte, NC.
Mouhammad Jumaa, Department of Neurology, ProMedica Toledo Hospital-University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.

Author Type(s)

Faculty

DOI

10.1148/radiol.251746

Journal Title

Radiology

First Page

e251746

Document Type

Article

Publication Date

1-1-2026

Department

Neurosurgery

Disciplines

Medicine and Health Sciences

Abstract

Background Chronic subdural hematomas (cSDHs) are associated with high recurrence risks following surgical evacuation. The EMBOLISE trial demonstrated that, compared with surgery alone, adjunctive middle meningeal artery embolization (MMAE) significantly reduced reoperation rates. However, given the limitations of the clinical end points of the trial, which may be subject to interrater variability and certain biases, the quantitative imaging metrics need to be evaluated. Purpose To evaluate the prespecified imaging end points of the EMBOLISE trial and assess the long-term resolution of cSDH through quantitative imaging analyses. Materials and Methods EMBOLISE was a multicenter, randomized, interventional trial conducted across 39 U.S. sites between December 2020 and August 2023. Prespecified secondary imaging end points included changes in hematoma volume and thickness and midline shifts from 24 hours to 90 days after the procedure at CT and MRI. The post hoc analyses performed herein extended the assessment to 180 days and included absolute hematoma metrics. Mixed-effects modeling was employed to adjust for confounders. Results Four hundred patients were enrolled in the EMBOLISE study, among whom 352 were included (mean age, 72 years ± 10.4 [SD]; 256 men). The mean cSDH volume was 126 mL at screening, with no intergroup differences. At 90 and 180 days, the MMAE plus surgery group had lower cSDH volumes (20.6 mL vs 28.9 mL [P = .03] and 19.4 mL vs 31.5 mL [P = .04], respectively). Mixed-effects models revealed a 6.9 mL (95% CI: -13.5, -0.40; approximately 25%) greater volume reduction and an 8.4 mL (95% CI: -15.2, -1.6; approximately 30%) lower absolute volume at 90 days in the MMAE group There was no evidence of a difference in the prespecified secondary imaging end points between the groups. Conclusion While the prespecified secondary imaging end points did not significantly differ, the absolute 90- and 180-day hematoma volumes were significantly lower in patients who received MMAE and surgery. Confounder-adjusted mixed-effects analysis indicated a greater reduction in hematoma volume with adjunctive MMAE. ClinicalTrials.gov identifier NCT04402632 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Ramasamy and Baker in this issue.

Link to Full Text

Share

COinS