Chronic Subdural Hematoma
Conditions
Keywords
cSDH, Chronic subdural hematoma, Coils, Embolization, eMMA
Brief summary
This is a pragmatic, prospective, multicenter, randomized controlled trial with intention to treat analysis. In which subjects will receive either unilateral or bilateral middle meningeal artery (MMA) embolization using coils for the treatment of unilateral chronic subdural hematomas (cSDH).
Detailed description
This study will enroll up to 400 subjects who will be randomized to receive either unilateral or bilateral coil MMA embolization. The study will assess the effect of the procedures on hematoma size and patient functional outcomes over 1 to 3 months of follow-up.
Interventions
DEVICEembolization therapy Bilateral
In the bilateral approach, both middle meningeal arteries are accessed and embolized using coils, regardless of hematoma location. Imaging guidance is used throughout the procedure to ensure proper coil placement, and post-procedure imaging confirms that both vessels are fully occluded.
DEVICEembolization therapy Unilateral
In the unilateral approach, the middle meningeal artery (MMA) on the side of the hematoma is accessed via a catheter and occluded using coils under imaging guidance. The procedure targets only the affected side, and follow-up imaging is used to confirm successful embolization and vessel occlusion.
Sponsors
Lahey Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Candidates for this study must meet ALL of the following criteria: 1. Subject is 18 years of age or older. 2. Subject has a diagnosis of chronic subdural hematoma with mass effect Determined by brain imaging (CT or MRI) and correlated clinical symptoms. 3. Pre-randomization modified Rankin Score (mRS) ≤3 a. Surgical Cohort: Assessment should reflect the subject's condition just prior to undergoing surgery. Assessment may be performed post-surgery using pre-surgical data. 4. Subdural Hematoma Size Medical Management Cohort: * Midline shift \< 10mm and hematoma thickness \> 10 mm as measured on coronal imaging perpendicular to the skull. * No focal deficit related to the chronic subdural hematoma requiring surgical intervention Surgical Cohort: • No requirement 5. A CT performed prior to randomization demonstrating stability of the hematoma. Stability is defined as no worsening of midline shift or increase in the size of the cSDH from the screening image that results in new or worsening clinical symptoms. 6. Patient or designated Legal Authorized Representative, confirms the patient has the mental capacity, willingness and ability to comply with protocol and follow-up requirements 7. In the opinion of the treating physician, MMA embolization is technically feasible, including evaluation of preoperative CTA, if available, or presence of a foramen spinosum bilaterally.
Exclusion criteria
* Candidates will be excluded from participation if ANY of the following apply: 1. Patients presenting with an acute SDH (e.g. patient with presenting with a SDH due to trauma); mixed density is permitted. 2. Subject presents with bilateral cSDHs requiring treatment (contralateral cSDH \<5mm and not requiring treatment is permitted. 3. Subject presents with Glasgow Coma Scale \< 9 4. Markwalder assessment \>4 5. cSDH that developed with underlying conditions such as vascular lesions, brain tumor, arachnoid cyst, spontaneous intracranial hypotension, end stage renal disease (ESRD) on hemodialysis, end stage liver disease or other comorbidities causing a coagulopathy 6. Prior carotid stent placement that crosses the origin of the External Carotid Artery (ECA) ipsilateral to the subdural hematoma 7. Presumed septic embolus, or suspicion of microbial superinfection 8. CT or MRI evidence of intra-cranial tumor or mass lesion 9. Significant contraindication to angiography (eg. kidney failure). 10. Life expectancy of less than 1-year 11. Women who are pregnant, lactating, plan on becoming pregnant during the course of the clinical investigation. We routinely do pregnancy tests prior to this procedure, to avoid radiation exposure to the fetus including radiation on follow up CT scans 12. Current involvement in an investigational (drug, device, etc.) clinical trial that may confound study endpoints. Subjects in observational, natural history, and/or epidemiological studies not involving intervention are eligible 13. Patient unwilling to follow SOC recommendations (e.g. refuses surgery or lifestyle modifications)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in cSDH Maximum thickness From Baseline on Non-contrast Head CT | Baseline, 1 month (3-6 weeks), and 3 months (10-14 weeks) | Change in maximum hematoma thickness (mm) and Volume (mL) measured on non-contrast head CT compared with baseline. Measurements will be performed using standardized imaging review. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Requiring Additional surgical Intervention | Through 3 months | Number of participants requiring additional surgical treatment after randomization, including initial surgical evacuation in the medical management cohort or repeat hematoma evacuation in the surgical cohort. |
| Change from Baseline in Modified Rankin scale (mRS) Score | Baseline, 1 month, and 3 months | Functional outcome measured using the Modified Rankin Scale (range 0-6). change from baseline will be reported. |
| Number of participants with Procedure-related Serious Adverse Events | through 3 months after embolization | Number of participants experiencing procedure related adverse events, including but not limited to ischemic stroke, intracranial hemorrhage, arterial dissection, vessel perforation, access-site complications requiring intervention, or death. |
Countries
United States
Contacts
CONTACTSandy L Alvarez, MD
PRINCIPAL_INVESTIGATORJonathan Pace, MD
Lahey Hospital & Medical Center
Outcome results
None listed