Middle meningeal artery embolization for chronic subdural hematoma: Does statin therapy improve outcomes? A propensity score-matched analysis

Background: Chronic subdural hematoma (cSDH) is a common condition in older adults, often treated with surgical-evacuation, though recurrence rates can reach 30%. Middle meningeal artery embolization (MMAE) has emerged as a treatment alternative. Statins have been explored as adjunct therapies, but literature regarding their combined use with MMAE is limited. Methods: Using TriNetX platform, we divided patients with cSDH who underwent MMAE into two groups: with adjuvant statins and without. Additionally, we divided patients with cSDH who underwent MMAE + Surgery into two groups: with adjuvant statins and without. Propensity score matching was conducted to minimize baseline differences. Primary outcomes included unplanned readmissions, surgical-evacuations, and mortality within 6 months of diagnosis. Results: We identified 2371 patients with cSDH who underwent MMAE, 1631 underwent MMAE alone, and 740 underwent MMAE + Surgery. Among MMAE alone group, 393 patients received statin therapy. While MMAE + Surgery group had 188 patients who received statin therapy. There was no significant difference in unplanned readmission rates between statin and nonstatin groups among MMAE alone group (36.6% vs. 39.7%; odds ratio (OR): 0.88; 95% confidence interval (CI): 0.66–1.17; P = 0.375). Similarly, rates of surgical-evacuation and mortality were comparable between the two groups; to MMAE + Surgery group's results were similar. There was no significant difference in unplanned readmission rates between statin and nonstatin groups (38.2% vs. 33.7%; OR: 1.22; 95% CI: 0.79–1.88; P = 0.377). Repeat surgical-evacuation and mortality rates were comparable. Conclusion: This study demonstrates that adding statins to MMAE does not improve outcomes in terms of the studied outcomes. While MMAE remains an effective treatment, the role of adjunct medical therapies requires further investigation.