Middle Meningeal Artery Embolization Is Associated With Lower Risk of Incident Dementia Among Patients With Subdural Hematoma

Huanwen Chen; Dhairya A Lakhani; Matthew K McIntyre; Massimo Caulo; Ajay Malhotra; Ryan Priest; Peter Kan; Dheeraj Gandhi; Marco Colasurdo

doi:10.1161/STROKEAHA.125.054182

Middle Meningeal Artery Embolization Is Associated With Lower Risk of Incident Dementia Among Patients With Subdural Hematoma

Stroke. 2026 Mar 2. doi: 10.1161/STROKEAHA.125.054182. Online ahead of print.

Authors

Huanwen Chen¹, Dhairya A Lakhani², Matthew K McIntyre³, Massimo Caulo⁴, Ajay Malhotra⁵, Ryan Priest⁶, Peter Kan⁷, Dheeraj Gandhi¹, Marco Colasurdo⁶

Affiliations

¹ Neurosurgery, University of Maryland Medical Center, Baltimore (H.C., D.G.).
² Neuroradiology, West Virginia University, Morgantown (D.A.L.).
³ Neurosurgery (M.K.M.), Oregon Health and Sciences University, Portland.
⁴ Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Italy (M. Caulo).
⁵ Radiology, Yale New Haven Hospital, CT (A.M.).
⁶ Interventional Radiology (R.P., M. Colasurdo), Oregon Health and Sciences University, Portland.
⁷ Neurosurgery, University of Texas Medical Branch at Galveston, Webster (P.K.).

PMID: 41766530
DOI: 10.1161/STROKEAHA.125.054182

Abstract

Background: Nonacute subdural hematoma (NASDH) is associated with cognitive dysfunction and decline. Middle meningeal artery embolization (MMAE) has shown efficacy in reducing NASDH recurrence and promoting hematoma resorption, but its potential impact on long-term cognitive outcomes is unexplored. This study aims to determine whether standalone MMAE is associated with reduced dementia risk compared with conservative management (CM) in dementia-free patients with nonsurgical NASDH.

Methods: This was a multicenter retrospective cohort study using the TriNetX US collaborative research network database. Adult patients with newly diagnosed NASDH who did not undergo surgical drainage were included. Patients with known dementia at the time of NASDH diagnosis were excluded. Patients who underwent standalone MMAE were compared with those who underwent CM only. The primary outcome was new-onset dementia during a 5-year study follow-up period. Secondary outcomes included all-cause mortality. One-to-one propensity score matching was performed to account for confounding and indication bias. Outcomes were compared using time-to-event analyses with Kaplan-Meier curves and Cox proportional hazards models.

Results: Of 175 868 patients with nonsurgical NASDH, 1991 underwent MMAE. After propensity score matching, 1972 patients remained in each group with similar baseline characteristics (all absolute standardized differences <0.10). Mean follow-up was 704 days for MMAE patients and 818 days for CM patients. Compared with CM, MMAE was associated with significantly lower 5-year probability of incident dementia (6.0% versus 11.4%; P<0.001; hazard ratio 0.55 [95% CI, 0.40-0.77]), representing a 45% reduction in risk. MMAE was also associated with significantly lower all-cause mortality (25.1% versus 32.1%; P=0.001).

Conclusions: Among nonsurgical, dementia-free patients with NASDH, standalone MMAE was associated with significantly reduced incident dementia risk compared with CM. These findings suggest MMAE may provide neurocognitive benefits beyond preventing hematoma progression, potentially through promoting hematoma resorption and preserving cortical integrity. Prospective studies are needed to confirm these hypothesis-generating observations and establish causality.

Keywords: cognitive dysfunction; conservative treatment; dementia; hematoma, subdural; meningeal arteries.