Title: Comparing Radial Versus Femoral Access For Middle Meningeal Artery Embolization In Patients With Chronic Subdural Hematoma: A Systematic Review And Meta-analysis
Authors: Muhammad Hassan Waseem, Zain ul Abideen, Sania Aimen, Justin Chen, Jamir Pitton Rissardo, and Brandon Lucke-Wold
Conference: 2025 CNS Annual Meeting, Los Angeles, CA
Introduction
Middle meningeal artery embolization (MMAE) is a growing treatment for chronic subdural hematoma (cSDH) with transradial access (TRA) emerging as a less invasive alternative to traditional transfemoral access (TFA).
Objective
This study aimed to compare the efficacy and safety of TRA versus TFA in MMAE in cSDH.
Methods
We searched PubMed, ScienceDirect, and the Cochrane Library from inception till October 2024. The Risk Ratios (RR) and Mean Difference (MD) were pooled under the random effects model using the Review Manager 5.4.1 for dichotomous and continuous outcomes. The clinically relevant endpoints analyzed were overall complications, access site complications, SDH expansion, procedural success, procedural failure, good functional outcome (mRS ≤ 2), length of hospitalization, and procedural duration. The quality of the studies was assessed by the Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test.
Results
Four studies pooling a total of 484 patients were included in this meta-analysis. TRA has a procedural success (RR= 1.00; 95%CI: [0.98,1.03]; p= 0.84; I2=0 %) and failure rate (RR= 0.99; 95%CI: [0.49,2.00]; p= 0.98; I2= 0%) comparable to the TFA. Overall complications were decreased in the TRA, but the results were statistically non-significant (RR= 0.72; 95%CI: [0.41,1.26]; p=0.25; I2= 0%). Other outcomes including access site complications (RR= 0.17; 95%CI:[0.02,1.47]; p=0.11; I2= 0 %), SDH expansion (RR= 1.13; 95%CI:[0.26,4.95]; p=0.87; I2= 0%), good functional outcome (mRS ≤ 2) (RR= 1.01; 95%CI:[0.83,1.22]; p=0.95; I2= 0%), length of hospitalization (MD= 1.01 days; 95%CI:[-0.89,2.91]; p= 0.30; I2= 0%), and procedural duration (MD= 13.92 min; 95%CI:[-46.14,73.97]; p= 0.65; I2= 84%) were also comparable between the 2 access routes.
Conclusions
Radial and Femoral access for MMAE in cSDH demonstrated comparable efficacy and safety across key success rate, failure rate, overall complications, access site complications, SDH expansion, good functional outcome, and procedural duration.
Citation
Waseem MH, Abideen Z, Aimen S, Chen J, Rissardo JP. Lucke-Wold B. Comparing Radial Versus Femoral Access For Middle Meningeal Artery Embolization In Patients With Chronic Subdural Hematoma: A Systematic Review And Meta-analysis. CNS Annual Meeting 2025;2025:5327. https://www.cns.org/poster-search?id=5327
Figure. Forest plots of overall complications, access-site complications, hematoma expansion, and procedural success comparing radial versus femoral access for MMA embolization.
Figure. Forest plots of procedural failure, functional outcome, hospital stay, and procedural duration comparing radial versus femoral access for MMA embolization.