Introduction: Middle meningeal artery embolization (MMAe) is increasingly utilized as a primary or secondary treatment for chronic subdural hematoma (cSDH) and is usually performed with liquid embolics or particles. Outcomes after MMAe with coiling as a standalone treatment, or an adjunct to other agents, have not been reviewed. Methods: A systematic review of the literature was performed to identify all original research that included patients who underwent standalone or adjunctive coiling for MMAe. The primary outcome was the need for rescue treatment defined as any unplanned reintervention for recurrent or residual cSDH. Results: A total of 10 studies comprising 346 patients (mean age 73 years, 39% female) who underwent MMAe with coils were included. The majority of embolizations were with coils and particles ( n = 176), followed by standalone coiling (137) and coiling with liquid embolics (120). The pooled rate of rescue treatment after embolization was 9.4% (95% CI 6.4–13.6, I²= 0). The pooled complication rate was 2.6% (95% CI 1.3–5.1, I²= 0). In the subgroup analysis of four studies reporting results after standalone coiling, the pooled rescue treatment rate was 8.2% (95% CI 4.0–15.9, I²= 0) and there were no complications. Conclusion: MMAe with coils is safe and potentially effective, but additional studies evaluating long-term clinical and radiographic results after standalone coiling are needed.

Background Recent studies support the effectiveness of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs). The RED 43 catheter has been introduced as a primary catheter for distal aspiration in acute ischemic stroke. In this multicenter study, we share our experience of using the RED 43 catheter for MT in DMVOs. Methods We identified consecutive patients with DMVOs who underwent primary aspiration thrombectomy using the RED 43 catheter at four high-volume stroke centers. We collected baseline clinical data, angiographic and clinical outcomes, and procedural complications. We divided the patients into two groups: those with primary DMVOs included patients who presented with more distal occlusions requiring mechanical thrombectomy; and those with secondary DMVOs being patients presenting with large vessel occlusion that later developed a DMVO. Primary outcomes included the rate of first pass effect, (modified treatment in cerebral infarction (mTICI) 2c or 3 on the first pass) and successful recanalization (mTICI≥2b at end of procedure). Secondary outcomes included good functional outcomes (modified Rankin Scale (mRS) 0–2 at 3 months), symptomatic intracerebral hemorrhage (sICH), asymptomatic intracerebral hemorrhage (aICH), subarachnoid hemorrhage (SAH), and in-hospital mortality. Results We identified 102 consecutive DMVO cases undergoing thrombectomy with the RED 43 catheter. The mean age was 70 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 9. The first pass effect (FPE) rate was 57% (primary) and 61% (secondary). Successful recanalization occurred in 83% (primary) and 87% (secondary). Good functional outcome was observed in 57% of patients. sICH occurred in one patient, and two patients died during hospitalization. We observed aICH in five (4.9%) patients and SAH in seven (6.9%) patients. Conclusion The RED 43 catheter is safe and effective for aspiration thrombectomy in primary and secondary DMVOs, with high recanalization rates and a favorable safety profile.

Background: Middle meningeal artery embolization (MMAe) is an effective treatment for chronic subdural hematoma. There are various procedural aspects related to liquid embolic (LE) injection that could influence radiographic resolution rates but require further study. Methods: A retrospective review of consecutive MMAe procedures using LEs performed at a single institution was performed. Technical factors investigated included type of LE, microcatheter position during embolization, number of branches embolized, and depth of penetration. Outcomes included rescue treatment within 90 days, complete hematoma and midline shift (MLS) resolution, and modified Rankin Scale (mRS) 0–2 at 90 days. Results: A total of 122 MMA embolizations performed on 95 patients (mean age 70.3 years, 66% male) were included. Hematoma recurrence requiring rescue treatment occurred for 12 hematomas (9.8%) among 10 patients. None of the technical factors were associated with rescue treatment, early MLS resolution, final hematoma resolution, final MLS resolution, or 90-day mRS 0–2. Contralateral penetration of embolisate was associated with increased odds of complete hematoma resolution (OR 8.4, 95% CI 1.79–50.38; p = 0.011) at early follow-up (median 2 months). The mean (± SD) hematoma reduction at early follow-up for contralateral penetration was 76.8% (37.2) compared to 56.5% (36) for only ipsilateral penetration ( p = 0.047). Conclusion: Contralateral penetration of LE may be associated with faster complete hematoma resolution but not the final radiographic result. These results require validation in larger cohorts.

Background: Coils are widely used in neurovascular interventions due to their effectiveness in achieving precise occlusion of blood vessels. Recently introduced SwiftPAC coil (Penumbra, Alameda, CA) is known for its innovative two-dimensional wave-like design, which makes it adaptable to irregular spaces within vessels with complex anatomical structures often encountered in the head and neck. Methods: We studied 18 consecutive patients treated using the SwiftPAC coil. The patients underwent pre-procedural imaging and then underwent transfemoral angiography and embolization. The primary outcome measure was technical success, defined as complete occlusion of the target vessel, complication rates, and resolution of clinical symptoms. Secondary outcome measures included the number and size of coils used, procedure duration, and length of hospital stay. These metrics were compared across different indications. Results: Our analysis included 18 patients (10 females and eight males) aged 16–88 years (mean age: 51 years). Indications for treatment included post-traumatic vessel sacrifices, preoperative embolization for tumors, severe epistaxis, temporo-mandibular joint dysfunction, acute and chronic subdural hematomas, direct carotid-cavernous fistula, aneurysm recurrence, and oropharyngeal hemorrhage. An average of 7 coils was deployed per patient (range: 1–22 coils). All procedures were technically successful except for one case, which was complicated by significant vasospasm preventing coil deployment. Six patients underwent elective embolization, while the remainder underwent urgent and emergent interventions. No major complications were observed. Conclusions: The SwiftPAC coil is a safe, effective, and efficient two-dimensional wave coil system delivered through a 0.0165″ microcatheter for a variety of indications ranging from middle meningeal artery to vessel sacrifice.

A 36-year-old woman presented to the emergency department after sustaining significant neck trauma from a dog bite, leading to bilateral carotid artery dissection and bilateral intracerebral stroke. The case involved complex injuries, including fractures of the cricoid and thyroid cartilage, and required an interdisciplinary approach for successful management. This unique presentation highlights the critical need for awareness and management strategies for severe dog bite injuries and offers insights into the challenges of diagnosing and treating traumatic bilateral carotid artery dissection. This case contributes to the limited literature on dog bite-related traumatic bilateral carotid injury and subsequent stroke, illustrating the importance of timely multidisciplinary care and public safety awareness.

The Single Pedicle Embolization of the Distal Middle Meningeal Artery using n-butyl cyanoacrylate (n-BCA) (SPEED-n technique) offers an innovative approach to treating chronic subdural hematomas by targeting the pathological subdural membranes with precise and efficient embolization.1 2 3 This technical video demonstrates the SPEED-n technique, which employs a single catheter and dilute n-BCA (15–20%) to achieve distal penetration of the middle meningeal artery (MMA) network while minimizing procedure time and risks (video 1). Video 1 -: Key features include a stepwise embolization strategy, leveraging inherent MMA anastomoses to ensure comprehensive vascular coverage and reduced non-target embolization. The method’s success hinges on careful anatomical considerations, precise imaging to delineate safety margins, and the advantages of dilute glue for delayed polymerization, facilitating safe catheter removal and preventing tip retention.4 5 6 This video serves as a practical guide for neurointerventionalists seeking efficient solutions for distal MMA embolization.