Neurointerventionalists are participating in a transformative moment in the field, from expanded thrombectomy indications,1 to the endovascular treatment of hydrocephalus,2 and endovascular brain–computer interfaces.3 Perhaps most consequential in recent years is the endovascular treatment of subacute or chronic subdural hematoma (cSDH) via middle meningeal artery embolization (MMAE). First reported in 20004 as salvage therapy in patients with high surgical comorbidities, this treatment has grown in popularity as its safety and efficacy have been studied. cSDH carries a high morbidity, mortality, and healthcare resource burden.5 Existing medical and surgical treatments, while effective, are imperfect, with recurrence rates of up to 20%6 and reoperation rates of 12%.7 These high rates were considered acceptable given the limited alternatives; adjunct medical treatment is at best moderately helpful,8 and at worst, harmful.9 In this setting, MMAE for cSDH emerged as a promising alternative. Recent meta-analysis found reoperation rates falling to 4.6% in cSDH treated with surgery and adjunctive MMAE, and 6.8% in cSDH treated with MMAE alone.10 These results, while favorable, were based primarily on case series and retrospective data collection. The results of three randomized, prospective trials of MMAE for the treatment of cSDH were simultaneously reported at the International Stroke Conference 2024 meeting. Embolization of the Middle Meningeal Artery With Onyx Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma (EMBOLISE) is an investigator-initiated but industry-sponsored multicenter, prospective, randomized, interventional, controlled, open label, adaptive design clinical trial of MMAE for patients with symptomatic cSDH across 39 centers in the USA using Onyx (Medtronic Neurovascular, Irvine, CA). EMBOLISE targeted enrollment of up to 600 patients across two arms. Patients with mild cSDH (defined as midline shift <5 mm, hematoma thickness ≤15 …

中文翻译：

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脑膜中动脉栓塞治疗慢性硬膜下血肿：有效治疗，前景光明

神经介入医师正在参与该领域的变革时刻，从扩大血栓切除术适应症1到脑积水的血管内治疗2和血管内脑机接口3。也许近年来最重要的是亚急性或慢性硬膜下血肿的血管内治疗（ cSDH）通过脑膜中动脉栓塞（MMAE）。这种治疗方法于 20004 年首次被报道，作为手术并发症较多的患者的挽救治疗，随着其安全性和有效性的研究，这种治疗方法越来越受欢迎。cSDH 具有很高的发病率、死亡率和医疗资源负担。5 现有的内科和手术治疗虽然有效，但并不完善，复发率高达 20%6，再手术率为 12%。7 鉴于这些高比率被认为是可以接受的有限的选择；辅助医疗治疗充其量是有一定帮助的，8 最坏的情况是有害的。9 在这种情况下，针对 cSDH 的 MMAE 成为一种有前途的替代方案。最近的荟萃分析发现，接受手术和辅助 MMAE 治疗的 cSDH 的再手术率降至 4.6%，单独接受 MMAE 治疗的 cSDH 的再手术率降至 6.8%。10 这些结果虽然有利，但主要基于病例系列和回顾性数据收集。2024 年国际卒中会议上同时报告了 MMAE 治疗 cSDH 的三项随机、前瞻性试验的结果。使用 Onyx 液体栓塞系统栓塞脑膜中动脉治疗亚急性和慢性硬膜下血肿 (EMBOLISE) 是一项由研究者发起但由行业赞助的多中心、前瞻性、随机、介入、对照、开放标签、适应性设计临床试验，美国 39 个中心使用 Onyx（美敦力神经血管公司，加利福尼亚州欧文市）对有症状的 cSDH 患者进行 MMAE。EMBOLISE 的目标是两个臂最多 600 名患者入组。轻度 cSDH 患者（定义为中线移位 <5 mm，血肿厚度 ≤15 …