Document resource
Background Middle meningeal artery (MMA) embolization is increasingly utilized for chronic subdural hematoma (cSDH), though the optimal anesthetic strategy remains undefined. We compared procedural and clinical outcomes between general anesthesia (GA) and conscious sedation (CS) in patients undergoing MMA embolization.Methods We performed a retrospective analysis of consecutive patients undergoing MMA embolization for cSDH from 2020-2024. Cases were stratified based on use of GA versus CS. Baseline characteristics, procedural variables, and outcomes were compared. Complications were categorized as neurological change, seizure, intracranial hemorrhage, ischemic stroke, access-site hematoma, and aspiration. Primary outcomes included procedural success, complications, length of stay (LOS), discharge disposition and functional status (modified Rankin Scale [mRS]) at last follow up.Results A total of 240 patients were included in which 172 patients underwent GA and 68 patients underwent CS. Baseline age and sex were similar between groups. Patients treated under GA had higher comorbidity burden and worse admission functional status (CCI: 5.03 vs 4.26, p=0.044; admission mRS: 1.92 vs 1.53, p=0.004). Procedural success rates were comparable (p>0.99) with no significant difference in overall complication rates between GA and CS (p=0.28). Fluoroscopy time was longer in the CS cohort (27.29 vs 23.19 minutes, p=0.044). However, CS was associated with shorter hospital length of stay (5.56 vs 7.72 days, p<0.001), improved functional outcomes at last follow-up (mRS: 0.72 vs 1.42, p<0.001), and more favorable discharge disposition to home or home health (p=0.049). There were no differences in hematoma resolution or mortality (p=0.98, 0.29).Conclusion Both GA and CS are safe and effective anesthetic strategies for MMA embolization, with comparable procedural success and complication profiles. CS is associated with shorter hospitalization and improved functional outcomes; however, these findings likely reflect baseline differences in patient selection. In appropriately selected patients, CS may represent a more favorable alternative to GA without compromising procedural safety.Disclosures A. Kareddy: None. A. Gong: None. O. Awan: None. E. Greenberg: None. A. Chitale: None.