Coil only middle meningeal artery embolization for the treatment of subdural hematoma: a single center experience.

Background and purpose: Middle meningeal artery embolization (MMAe) has emerged as an effective adjunct or alternative to surgery for subdural hematoma (SDH). While particles and liquid embolic agents are commonly used, data on standalone coils for embolization remains limited. We aim to evaluate the safety and efficacy of coil only embolization of the middle meningeal artery for the treatment of subdural hematoma in one of the largest single-center series to date. Materials and methods: We retrospectively reviewed patients who underwent MMA embolization with standalone coils between July 2023 and June 2025. Demographics, procedural characteristics, complications, and radiographic outcomes were collected. Imaging outcomes were assessed at 1 month, 3 months, and 6 months post-procedure. Primary efficacy outcome was unplanned repeat surgical drainage; primary safety outcome was major procedural complications. Results: Seventy seven patients underwent 101 standalone coil embolizations. Mean age was 71.3 years, and 76.6% were male. Bilateral embolization was performed in 31.2% of cases, and 77.9% of procedures utilized radial access. Technical success was achieved in 100% of cases. Radiographic improvement or resolution was observed in 46.6% at 1 month, 69.3% at 3 months, and 95.1% at 6 months. Four hematomas recurred, with only two requiring repeat surgical drainage. No major procedural complications occurred. Distal coil penetration was associated with higher rates of near-complete or complete resolution, though this was not statistically significant. Conclusion: Coil only MMAe is a safe and effective treatment for subdural hematoma, demonstrating high technical success, low retreatment rates, and favorable radiographic outcomes. These findings support coils as a viable standalone embolic option.