Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma

Santiago Gomez-Paz; Mohamed M. Salem; Cordell Baker; Okkes Kuybu; Georgios S. Sioutas; Kate T. Carroll; Mira Salih; Adam A. Dmytriw; Jane Khalife; William Smith; Diego Alejandro Ortega Moreno; Robert W. Regenhardt; Nicole M. Cancelliere; Alejandro M. Spiotta; Omar Tanweer; Christopher J. Stapleton; Michael Lang; Vitor M. Pereira; Aman B. Patel; Adnan H. Siddiqui; Elad I. Levy; Christopher S. Ogilvy; Daniel Tonetti; Ajith J. Thomas; Visish M. Srinivasan; Brian T. Jankowitz; Michael R. Levitt; Bradley A. Gross; Jan Karl Burkhardt; Ramesh Grandhi

doi:10.1177/15910199251339536

Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma

Santiago Gomez-Paz
, Mohamed M. Salem
, Cordell Baker
, Okkes Kuybu
, Georgios S. Sioutas
, Kate T. Carroll
, Mira Salih
, Adam A. Dmytriw
, Jane Khalife
, William Smith
, Diego Alejandro Ortega Moreno
, Robert W. Regenhardt
, Nicole M. Cancelliere
, Alejandro M. Spiotta
, Omar Tanweer
, Christopher J. Stapleton
, Michael Lang
, Vitor M. Pereira
, Aman B. Patel
, Adnan H. Siddiqui

Elad I. Levy, Christopher S. Ogilvy, Daniel Tonetti, Ajith J. Thomas, Visish M. Srinivasan, Brian T. Jankowitz, Michael R. Levitt, Bradley A. Gross, Jan Karl Burkhardt, Ramesh Grandhi

Neurosurgery

University of Utah
University of Pennsylvania
University of Colorado Anschutz Medical Campus
University of Pittsburgh
University of Washington
Beth Israel Deaconess Medical Center
Harvard University
Cooper University Health Care
University of Toronto
Medical University of South Carolina
Baylor College of Medicine
JFK New Jersey Neuroscience Institute

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: We investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery. Methods: This multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders. Results: A total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65–81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25–0.95, p = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43–3.51, p < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25–0.69, p = 0.001) to be independent at last follow-up. Conclusion: This study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.

Original language	English
Article number	15910199251339536
Journal	Interventional Neuroradiology
DOIs	https://doi.org/10.1177/15910199251339536
State	Accepted/In press - 2025

Keywords

Chronic subdural hematoma
healthcare disparities
middle meningeal artery embolization
racial groups

Access to Document

10.1177/15910199251339536

Cite this

Gomez-Paz, S., Salem, M. M., Baker, C., Kuybu, O., Sioutas, G. S., Carroll, K. T., Salih, M., Dmytriw, A. A., Khalife, J., Smith, W., Moreno, D. A. O., Regenhardt, R. W., Cancelliere, N. M., Spiotta, A. M., Tanweer, O., Stapleton, C. J., Lang, M., Pereira, V. M., Patel, A. B., ... Grandhi, R. (Accepted/In press). Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma. Interventional Neuroradiology, Article 15910199251339536. https://doi.org/10.1177/15910199251339536

@article{99165ec8fa304e4e9c6fc1bb0e2d679e,

title = "Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma",

abstract = "Background: We investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery. Methods: This multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders. Results: A total of 557 patients underwent 663 MMAEs, including 323 White (58\%), 150 Black (27\%), 35 Hispanic (6\%), 29 Asian (5\%) patients, and 20 patients (4\%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65{\textendash}81) years, and 412 (74\%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66\%) and adjunct treatment for 188 (34\%). Black patients had a 51\% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95\% confidence interval [CI] 0.25{\textendash}0.95, p = 0.034). White patients were twice as likely (11\% difference; adjusted OR 2.24; 95\% CI 1.43{\textendash}3.51, p < 0.001) and Black patients 59\% less likely (6\% difference; adjusted OR 0.41; 95\% CI 0.25{\textendash}0.69, p = 0.001) to be independent at last follow-up. Conclusion: This study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.",

keywords = "Chronic subdural hematoma, healthcare disparities, middle meningeal artery embolization, racial groups",

author = "Santiago Gomez-Paz and Salem, \{Mohamed M.\} and Cordell Baker and Okkes Kuybu and Sioutas, \{Georgios S.\} and Carroll, \{Kate T.\} and Mira Salih and Dmytriw, \{Adam A.\} and Jane Khalife and William Smith and Moreno, \{Diego Alejandro Ortega\} and Regenhardt, \{Robert W.\} and Cancelliere, \{Nicole M.\} and Spiotta, \{Alejandro M.\} and Omar Tanweer and Stapleton, \{Christopher J.\} and Michael Lang and Pereira, \{Vitor M.\} and Patel, \{Aman B.\} and Siddiqui, \{Adnan H.\} and Levy, \{Elad I.\} and Ogilvy, \{Christopher S.\} and Daniel Tonetti and Thomas, \{Ajith J.\} and Srinivasan, \{Visish M.\} and Jankowitz, \{Brian T.\} and Levitt, \{Michael R.\} and Gross, \{Bradley A.\} and Burkhardt, \{Jan Karl\} and Ramesh Grandhi",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

doi = "10.1177/15910199251339536",

language = "English",

journal = "Interventional Neuroradiology",

issn = "1591-0199",

publisher = "SAGE Publications Inc.",

}

Gomez-Paz, S, Salem, MM, Baker, C, Kuybu, O, Sioutas, GS, Carroll, KT, Salih, M, Dmytriw, AA, Khalife, J, Smith, W, Moreno, DAO, Regenhardt, RW, Cancelliere, NM, Spiotta, AM, Tanweer, O, Stapleton, CJ, Lang, M, Pereira, VM, Patel, AB, Siddiqui, AH , Levy, EI, Ogilvy, CS, Tonetti, D, Thomas, AJ, Srinivasan, VM, Jankowitz, BT, Levitt, MR, Gross, BA, Burkhardt, JK & Grandhi, R 2025, 'Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma', Interventional Neuroradiology. https://doi.org/10.1177/15910199251339536

TY - JOUR

T1 - Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma

AU - Gomez-Paz, Santiago

AU - Salem, Mohamed M.

AU - Baker, Cordell

AU - Kuybu, Okkes

AU - Sioutas, Georgios S.

AU - Carroll, Kate T.

AU - Salih, Mira

AU - Dmytriw, Adam A.

AU - Khalife, Jane

AU - Smith, William

AU - Moreno, Diego Alejandro Ortega

AU - Regenhardt, Robert W.

AU - Cancelliere, Nicole M.

AU - Spiotta, Alejandro M.

AU - Tanweer, Omar

AU - Stapleton, Christopher J.

AU - Lang, Michael

AU - Pereira, Vitor M.

AU - Patel, Aman B.

AU - Siddiqui, Adnan H.

AU - Levy, Elad I.

AU - Ogilvy, Christopher S.

AU - Tonetti, Daniel

AU - Thomas, Ajith J.

AU - Srinivasan, Visish M.

AU - Jankowitz, Brian T.

AU - Levitt, Michael R.

AU - Gross, Bradley A.

AU - Burkhardt, Jan Karl

AU - Grandhi, Ramesh

PY - 2025

Y1 - 2025

N2 - Background: We investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery. Methods: This multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders. Results: A total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65–81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25–0.95, p = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43–3.51, p < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25–0.69, p = 0.001) to be independent at last follow-up. Conclusion: This study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.

AB - Background: We investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery. Methods: This multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders. Results: A total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65–81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25–0.95, p = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43–3.51, p < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25–0.69, p = 0.001) to be independent at last follow-up. Conclusion: This study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.

KW - Chronic subdural hematoma

KW - healthcare disparities

KW - middle meningeal artery embolization

KW - racial groups

UR - https://www.scopus.com/pages/publications/105005217252

U2 - 10.1177/15910199251339536

DO - 10.1177/15910199251339536

M3 - Article

AN - SCOPUS:105005217252

SN - 1591-0199

JO - Interventional Neuroradiology

JF - Interventional Neuroradiology

M1 - 15910199251339536

ER -

Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this