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Introduction/Purpose Recent clinical trials have demonstrated the safety and efficacy of middle meningeal artery embolization (MMAE) in decreasing recurrence after a chronic subdural hematoma (SDH), but the long-term outcomes remain to be evaluated. We, therefore, sought to evaluate long-term mortality and incident dementia in SDH patients treated with MMAE in a large, nationally-representative sample.Materials and Methods We performed a retrospective cohort study using inpatient and outpatient claims data between 2016-2022 from a nationally representative 5% sample of Medicare beneficiaries ≥ 65 years of age. We included all patients with a non-traumatic SDH. Beneficiaries with prevalent dementia were excluded. The exposure was MMAE. The co-primary outcomes were mortality and incident dementia, identified using validated ICD-10-CM diagnosis codes. To study the relationship between MMAE and outcomes, we used Cox regression after controlling for demographics and vascular comorbidities.Results Of the 23,177 SDH patients included in the analysis, 405 (1.7%) were treated with MMAE. During a median follow up of 1.8 years (IQR, 0.4-3.1), the cumulative incidence of incident dementia was 4.7% (3.1-7.1) with MMAE and 8.7% (8.3-9.0) in those not treated with MMAE. Treatment with MMAE was associated with a significantly lower risk of mortality (30.9% vs. 40.2%; aHR, 0.75; 95% CI, 0.62- 0.91) and lower risk of incident dementia (6.7% vs. 16.0%; aHR, 0.43; 95% CI, 0.28- 0.67).Conclusion In a large nationwide cohort of Medicare beneficiaries, treatment of SDH with MMAE was associated with decreased mortality and lower rates of incident dementia.Disclosures A. Dicpinigaitis: None. C. Zhang: None. A. Merkler: None. J. Mocco: None. H. Kamel: None. J. Knopman: 1; C; co-PI of EMBLOLISE trial. S. Murthy: None.