Evidence map›Paper›PMID 42708118›Full record

ArticleStroke (Hoboken, N.J.)2026

Timing of Middle Meningeal Artery Embolization and Surgery: Analysis of the EMBOLISE Trial.

Maxim Mokin, Jared Knopman, Jason M Davies, Ameer E Hassan, Robert E Harbaugh, Alexander Khalessi, Jens Fiehler, Elad I Levy, Bradley A Gross, Ramesh Grandhi and 35 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04402632 (A Study of the Embolization of the Middle Meningeal Artery With ONYX™ Liquid Embolic System In the Treatment of Subacute and Chronic Subdural HEmatoma), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04402632 nacompletednot on this map

A Study of the Embolization of the Middle Meningeal Artery With ONYX™ Liquid Embolic System In the Treatment of Subacute and Chronic Subdural HEmatoma (EMBOLISE)

TypeinterventionalSponsorMedtronic Neurovascular Clinical AffairsRan2020 to 2025Enrolled600ConditionsSubdural HematomaArmsSurgical Management, Onyx™ Liquid Embolic System (LES) Embolization, Observation Only
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

45 authors.

Maxim MokinDepartment of Neurosurgery, Brain and Spine, Tampa General Hospital, University of South Florida (M.M.).ORCID https://orcid.org/0000-0003-4270-8667
Jared KnopmanDepartment of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center (J.K.).ORCID https://orcid.org/0000-0001-5871-5517
Jason M DaviesDepartments of Neurosurgery and Biomedical Informatics (J.M.D.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY.ORCID https://orcid.org/0000-0002-5225-3072
Ameer E HassanDepartment of Neuroscience, Valley Baptist Medical Center-University of Texas Rio Grande Valley, Harlingen (A.E.H.).ORCID https://orcid.org/0000-0002-7148-7616
Robert E HarbaughDepartments of Neurosurgery and Engineering Science & Mechanics, Penn State University, Hershey (R.E.H.).
Alexander KhalessiDepartments of Neurological Surgery, Surgery, Radiology and Neurosciences, University of California San Diego (A.K.).
Jens FiehlerDiagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.).ORCID https://orcid.org/0000-0001-8533-7478
Elad I LevyDepartments of Neurosurgery and Radiology (E.I.L., A.H.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY.ORCID https://orcid.org/0000-0002-6208-3724
Bradley A GrossDepartment of Neurosurgery, University of Pittsburgh Medical Center, PA (B.A.G.).ORCID https://orcid.org/0000-0002-6999-7967
Ramesh GrandhiDepartment of Neurosurgery, University of Utah School of Medicine, Salt Lake City (R.G.).ORCID https://orcid.org/0000-0001-9000-6083
Jason TarpleyDepartment of Radiology (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA.
Walavan SivakumarDepartment of Neurosurgery (W.S.), Providence Little Company of Mary Medical Center, Torrance, CA.ORCID https://orcid.org/0000-0002-1367-2100
Mark BainCerebrovascular Center, Cleveland Clinic, OH (M.B.).
R Webster CrowleyDepartment of Neurosurgery, Rush University, Chicago, IL (R.W.C.).ORCID https://orcid.org/0000-0002-9197-0437
Thomas W LinkDepartment of Neurosurgery, North Shore University Hospital at Northwell Health, Great Neck, NY (T.W.L.).ORCID https://orcid.org/0000-0003-1325-8847
Justin F FraserDepartments of Neurological Surgery, Neurology, Radiology, Otolaryngology, and Neuroscience, University of Kentucky, Lexington (J.F.F.).ORCID https://orcid.org/0000-0002-5980-3989
Michael R LevittDepartments of Neurological Surgery, Radiology, Neurology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle (M.R.L.).ORCID https://orcid.org/0000-0003-3612-3347
Peng Roc ChenDepartment of Neurosurgery, Memorial Hermann-Texas Medical Center, Houston (P.R.C.).ORCID https://orcid.org/0000-0001-8438-132X
Ricardo A HanelLyerly Neurosurgery, Baptist Medical Center Jacksonville, FL (R.A.H.).ORCID https://orcid.org/0000-0001-7195-5806
Joe D BernardNeuroendovascular Surgery, Neuroradiology, Atrium Health Carolinas Medical Center, Carolina Neurosurgery and Spine Associates, Charlotte, NC (J.D.B.).ORCID https://orcid.org/0000-0002-4270-4458
Mouhammad JumaaDepartment of Neurology and Interventional Neurology, University of Toledo Medical Center, University of Toledo, OH (M.J.).ORCID https://orcid.org/0000-0002-7165-797X
Patrick YoussefDepartment of Neurological Surgery, The Ohio State University, Wexner Medical Center, Columbus (P.Y.).
Marshall C CressOrlando Health Neuroscience Institute Neurosurgery Group, Orlando Health Orlando Regional Medical Center, FL (M.C.C.).ORCID https://orcid.org/0000-0001-7510-7775
Mohammad Imran ChaudryDepartment of Diagnostic Radiology and Neuroradiology, Prisma Health Southeastern Neurosurgical and Spine Institute, Greenville, SC (M.I.C.).ORCID https://orcid.org/0000-0002-5699-1662
Hakeem J ShakirDepartment of Neurosurgery, University of Oklahoma Health Sciences Center (H.J.S.).
Walter S LesleyDepartment of Neurosurgery, Baylor Scott & White Health, Temple, TX (W.S.L.).
Joshua BillingsleyDepartment of Neurosciences, Advocate Lutheran General Hospital, Park Ridge, IL (J.B.).
Jesse JonesDepartments of Neurosurgery and Radiology, University of Alabama School of Medicine, Birmingham (J.J.).ORCID https://orcid.org/0000-0002-2682-9736
Matthew J KochDepartment of Neurosurgery, University of Florida, Gainesville (M.J.K.).
Alexandra R PaulDepartment of Neurosurgery, Albany Medical Center, NY (A.R.P.).ORCID https://orcid.org/0000-0002-8315-5870
William J MackDepartment of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles (W.J.M.).ORCID https://orcid.org/0000-0003-0970-2546
Joshua W OsbunDepartments of Neurosurgery, Radiology and Neurology, Washington University in St. Louis, MO (J.W.O.).ORCID https://orcid.org/0000-0003-4308-9669
Kathleen DlouhyDepartment of Neurosurgery, University of Iowa Hospitals and Clinics (K.D.).
Jonathan A GrossbergDepartment of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G.).ORCID https://orcid.org/0000-0002-1152-8826
Christopher P KellnerDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.K.).ORCID https://orcid.org/0000-0003-4604-8205
Daniel H SahleinDepartment of Neurointerventional Radiology, Goodman Campbell Brain and Spine, Indianapolis, IN (D.H.S.).ORCID https://orcid.org/0000-0002-6591-9427
Justin SantarelliDepartment of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla (J.S.).
Clemens M SchirmerDepartment of Neurosurgery, Geisinger and Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA (C.M.S.).ORCID https://orcid.org/0000-0003-1743-8781
Paul MazarisDepartment of Neurosurgery, Michigan State University College of Human Medicine, Grand Rapids (P.M.).
Jesse J LiuDepartment of Neurological Surgery, Oregon Health & Science University, Portland (J.J.L.).ORCID https://orcid.org/0000-0001-5819-7860
Aniel Q MajjhooDepartment of Neurology, McLaren Flint Hospital, Flint, MI (A.Q.M.).
Thomas WolfeAurora Neuroscience Innovation Institute, Milwaukee, WI (T.W.).
Neil V PatelInterventional Neuroradiology, Beth Israel Lahey Health, Lahey Hospital & Medical Center, Burlington, MA (N.V.P.).ORCID https://orcid.org/0000-0002-3396-5568
Christopher RoarkDepartment of Neurosurgery at University of Colorado, Denver (C.R.).
Adnan H SiddiquiDepartments of Neurosurgery and Radiology (E.I.L., A.H.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY.ORCID https://orcid.org/0000-0002-9519-0059

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe EMBOLISE trial (The Embolization of the Middle Meningeal Artery With Onyx Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma) demonstrated that middle meningeal artery embolization as an adjunct to surgical drainage reduces recurrence of symptomatic subacute and chronic subdural hematomas. We performed a subgroup analysis of the EMBOLISE surgical cohort to determine how the timing of embolization relative to surgery impacted various outcomes.

methodsWe performed a post hoc subgroup analysis to examine the association of the timing of embolization relative to surgery with the primary end point (hematoma reoperation within 90 days), secondary end points (clinical and radiographic outcomes), and safety end points (serious adverse events, neurological death, all-cause death, and stroke).

resultsMiddle meningeal artery embolization before surgery (embolization-first group) and middle meningeal artery embolization after surgery (surgery-first group) were performed in 107 and 78 patients, respectively. Demographics and baseline clinical characteristics of the 2 groups were similar. The core laboratory confirmed the procedure to be successful in all patients with similar rates of distal penetration of Onyx into middle meningeal artery branches at the end of the embolization procedure in both groups (49.5% and 48.7%, respectively,

conclusionsPerforming surgical drainage before embolization in patients with subacute and chronic subdural hematomas may help minimize treatment failures and enhance hematoma resolution. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04402632.

Indexed as

drainagehematoma, subdural, chronicmeningeal arteriesstroketomography

Identifiers

PMID42708118
PMCPMC13549615

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