{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:23:56Z","timestamp":1792070636900,"version":"4.4.0"},"reference-count":141,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p xml:lang=\"en\">Emerging evidence from observational studies, meta\u2010analyses, and clinical trials has reshaped the treatment landscape of chronic subdural hematoma (CSDH). This guideline provides updated recommendations on diagnosis, patient selection, and medical, surgical, and endovascular management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p xml:lang=\"en\">The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee formed a writing group of interdisciplinary experts to review current literature. Recommendations were based on clinical trial data, observational studies, and expert consensus, following the Society of Vascular and Interventional Neurology Class of Recommendation and Level of Evidence framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      EMBOLISE (Embolization of the Middle Meningeal Artery With ONYX Liquid Embolic System for Subacute and Chronic Subdural Hematoma), STEM (SQUID Trial for the Embolization of the Middle Meningeal Artery for Treatment of Chronic Subdural Hematoma), MAGIC\u2010MT (Managing Non\u2010acute Subdural Hematoma Using Liquid Materials: A Chinese Randomized Trial of MMA Treatment), and MEMBRANE (Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n\u2010butyl cyanoacrylate) trials highlight the efficacy and safety of middle meningeal artery embolization (MMAE) in CSDH. EMBOLISE (n = 400; MMAE with surgery, n = 197; surgery alone, n = 203) showed that MMAE plus surgery reduced 90\u2010day hematoma recurrence to 4.1% versus 11.3% with surgery alone (relative risk = 0.36; 95% CI = 0.11\u20130.80;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.008). Functional deterioration was 11.9% versus 9.8%, and 90\u2010day mortality was 5.1% versus 3.0%. Serious embolization\u2010related events, including 2 disabling strokes, occurred in 2.0% by 30 days. The STEM trial (310 patients enrolled: MMAE plus standard treatment, n = 149; standard treatment alone, n = 161) found that MMAE with Squid significantly reduced 180\u2010day recurrent\/residual hematoma or reoperation\/rescue surgery to 16% versus 36% with standard treatment (odds ratio = 0.36; 95% CI = 0.20\u20130.66;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). 30\u2010day mortality or major disabling stroke was 3% in both groups. However, 180\u2010day mortality was 8% with the MMAE group, and 5% with standard treatment, and no death was attributed to MMAE or embolic agent. MAGIC\u2010MT (722 patients; MMAE plus standard treatment, n = 360; standard treatment alone, n = 362) reported 90\u2010day symptomatic recurrence or progression in 6.7% of the MMAE group (using Onyx) versus 9.9% in the standard treatment group (difference: \u22123.3%; 95% CI: \u22127.4\u20130.8;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.10). Serious adverse events were less common in the MMAE group (6.7% versus 11.6%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02). The MEMBRANE trial (376 patients; MMAE plus standard treatment, n = 188; standard treatment alone, n = 188) found that MMAE using n\u2010butyl cyanoacrylate plus surgery improved outcomes at 6 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p xml:lang=\"en\">These results suggest that MMAE plus standard treatment of CSDH shows promising results and may become a standard of care for managing CSDH in selected patients. These guidelines provide evidence\u2010based recommendations for the diagnosis, patient selection, and treatment of CSDH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.125.001814","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T07:04:47Z","timestamp":1757919887000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Consensus Statement on Middle Meningeal Artery Embolization in Chronic Subdural Hematoma Treatment: A Guideline from the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Committee"],"prefix":"10.1161","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8568-1543","authenticated-orcid":false,"given":"Farhan","family":"Siddiq","sequence":"first","affiliation":[{"name":"University of Missouri, 1 Hospital Drive","place":["Columbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Shakir","sequence":"additional","affiliation":[{"name":"University of Missouri, 1 Hospital Drive","place":["Columbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Boston Medical Center","place":["Boston"]},{"name":"Boston University School of Medicine","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameer E.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Valley Baptist Medical Center","place":["Harlingen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Abdalkader","sequence":"additional","affiliation":[{"name":"Boston Medical Center","place":["Boston"]},{"name":"Boston University School of Medicine","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia L.","family":"Kenmuir","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Altoona"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"Neurovascular Imaging Research Core, UCLA","place":["Los Angeles"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Novakovic","sequence":"additional","affiliation":[{"name":"UT Southwestern","place":["Dallas"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahram","family":"Majidi","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"UTHealth","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"El\u2010Ghanem","sequence":"additional","affiliation":[{"name":"HCA Houston Northwest\/University of Houston College of Medicine","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Ortega\u2010Gutierrez","sequence":"additional","affiliation":[{"name":"University of Iowa Hospitals and Clinics","place":["Iowa City"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldo R.","family":"Guerrero","sequence":"additional","affiliation":[{"name":"University of South Florida","place":["Tampa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer M.","family":"Malik","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine","place":["Miami"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"402","DOI":"10.2176\/nmc.ra.2016-0337","article-title":"Chronic subdural hematoma in elderly patients: is this disease benign?","volume":"57","author":"Uno M","year":"2017","unstructured":"Uno M, Toi H, Hirai S. 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