Abstract 380: Proximal coiling versus Liquid Agents in Treatment for Middle Meningeal Artery Embolization: A single center study with 72 patients

Background Various embolic materials, including n‐butyl cyanoacrylate (nBCA), Onyx, and coils, have been used in MMA embolization. The choice of embolic material may influence procedural outcomes, including the extent of MMA branch embolization and the risk of complications. To address this gap, we compared clinical and radiological outcomes for proximal coiling vs liquid agents in the treatment of subdural hematomas (SDHs). Methods A retrospective case‐control study assessed 72 patients with SDH who met inclusion criteria and underwent either proximal coiling (n=10) or liquid embolization (n=62) between 2022 and 2023. Demographic data, clinical presentation, radiological membrane thickness, procedure time, complications, and follow‐up outcomes were recorded. Clinical outcomes were assessed using the modified Rankin Scale (mRS) at admission and at the 90‐day follow‐up. Descriptive statistics for baseline characteristics and outcomes were calculated Univariate and multivariate correlations were investigated using binomial and multinomial logistic regressions with reporting of the odds ratios (ORs). Results Overall cohort had a mean age of 68.1 years, with no significant differences between the coil and liquid groups in age, gender distribution, or comorbidities. Significant differences were observed in preoperative SDH width (p<0.01) and membrane presence (p=0.04) between the two groups. Clinical outcomes at 90‐day follow‐up showed no statistically significant differences in mRS scores between the coil and liquid agent groups. Complications were reported in 4.2% of the total cohort, occurring only in the liquid embolic group, with no complications in the coil group. Retreatment was required in 5.6% of patients, with one case in the coil group and three cases in the liquid group, showing no significant difference (p>0.95). The overall mean mRS score improved significantly from 3.1 at admission to 1.0 at 90 days, with no significant difference in the degree of improvement between the two groups (p=0.50). The mean procedural duration was 40.2 minutes, with the coil group having a slightly longer mean duration (48.3 minutes) compared to the liquid group (39.0 minutes), though this difference was not statistically significant (p=0.07) Conclusion MMA embolization using either coils or liquid embolic agents is an effective and safe treatment for cSDH, with both modalities showing comparable clinical outcomes and procedure times. While the liquid embolic group had a slightly higher rate of complications, this was not statistically significant. Both treatment options resulted in substantial improvements in mRS scores, suggesting their efficacy in reducing the recurrence and managing cSDH. Proximal coiling could be an alternative option, whereas the liquid agents or DMSO compatible are not available for MMA embolization