Determinants of Radiation Exposure in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Single-Center Cohort Study

PURPOSE: To identify patient- and procedure-related factors associated with radiation exposure during middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH), with particular focus on embolic agent (particle vs. liquid) and arterial access route (transradial vs. transfemoral). METHODS: ). Univariable and multivariable linear regression analyses were performed to assess associations between DAP and age, sex, access route, treated side (unilateral vs bilateral), embolic agent, anesthesia, interventionalist, and guiding catheter. RESULTS: (84.1-161.6) for bilateral embolization. Univariable analyses showed no significant association between DAP and age, sex, embolic agent, access route, anesthesia, guiding catheter, or interventionalist. In multivariable analysis, unilateral right and left MMA embolization remained independently associated with significantly lower DAP compared with bilateral procedures, while embolic agent and access route were not significantly associated with radiation exposure. CONCLUSION: In MMA embolization for cSDH, radiation exposure is primarily driven by procedural extent, with higher DAP in bilateral than in unilateral embolization, whereas the choice of embolic material and arterial access route is not associated with radiation dose. These findings support selecting embolic agents and access routes based on anatomical and clinical considerations rather than radiation concerns.