Document resource
Background Patients with thrombocytopenia are among those most likely to develop chronic subdural hematoma (cSDH), yet are often excluded from trials evaluating middle meningeal artery embolization (MMAE) due to their comorbidities. We sought to characterize procedural efficacy and outcomes following MMAE across the spectrum of platelet counts.Methods A multicenter retrospective cohort study was performed across 16 institutions in North America and Europe. The cohort consisted of 1,352 MMAE procedures across 1,233 patients with cSDH. Pre-procedural platelet count was categorized as severe thrombocytopenia (<100K platelets), mild (100K-150K), and normal (≥150K). Primary endpoints were 90-day retreatment rate and 90-day all-cause mortality.Results The cohort had a mean age of 72.8 ± 12.3 years, mean pre-operative hematoma thickness of 15.4 ± 7.9 mm, and 15.4% underwent concurrent surgical decompression. Overall, 22.5% of patients were thrombocytopenic at the time of embolization (severe: n=109, 8.6%; mild: n=175, 13.9%). Retreatment rates were comparable across platelet strata (7.4% vs 13.3% vs 10.3% for <100K, 100-150K, and ≥150K, respectively; p=0.272), as were procedural complication rates (4.6% vs 8.6% vs 4.4%; p=0.062). Hematoma resolution trajectories were similar regardless of platelet count. However, 90-day all-cause mortality was significantly elevated in the severe thrombocytopenia group (29.6% vs 10.0% vs 9.8%; p<0.001; OR 3.87, 95% CI 2.43-6.15).Conclusions MMAE achieves equivalent procedural efficacy and comparable retreatment rates across all platelet strata. For appropriately selected patients, MMAE is a reasonable treatment approach even in the setting of severe thrombocytopenia. Pre-procedural platelet count should inform prognostic counseling regarding systemic mortality risk but should not preclude embolization.Disclosures A. Gajjar: None. S. Mohamed: None. T. Sorenson: None. A. Custozzo: None. G. Sioutas: None. R. Jabarkheel: None. O. Kuybu: None. J. Khalife: None. D. Tonetti: None. G. Cortez: None. A. Dmytriw: None. D. Alejandro Ortega Moreno: None. W. Smith: None. A. Paul: None. K. Carroll: None. Z. Abecassis: None. J. Francisco Ruiz Rodriguez: None. O. Shekhtman: None. A. Nguyen Hoang: None. H. Riina: None. A. Patel: None. R. Hanel: None. A. Thomas: None. M. Lang: None. B. Gross: None. A. Boulos: None. V. Srinivasan: None. J. Burkhardt: None.Abstract E-076 Figure 1A) Mortality by pre-procedural platelet count; B) Retreatment by pre-procedural platelet count