The SQUID Trial for the Embolization of the Middle Meningeal Artery for Treatment of Chronic Subdural Hematoma

OBJECTIVES	To investigate the effect of adjunctive middle meningeal artery embolization (MMAe) with SQUID™ (Balt USA), a non-adhesive liquid embolic agent, on the risk of treatment failure among patients receiving either surgical (burr-hole evacuation or subdural evacuating port system [SEPS] drainage) or nonsurgical standard treatment for chronic subdural hematoma.
STUDY	Prospective, international, multicenter, open-label, interventional, randomized 1:1 controlled trial, conducted from November 2020 to May 2023 at 32 participating sites in the United States (1-year follow-up is ongoing).
POPULATION	Patients ≥30 years of age with pre-morbid mRS 0-1 within the previous 12 months, diagnosis of chronic subdural hematoma (cSDH) defined as ≥50% of the volume is isodense or hypodense to normal; cortical gray matter on CT imaging, thickness of the cSDH ≥10 mm, and mass effect upon the subjacent brain-local cortical flattening or midline shift resulting in clear neurological symptoms (headache, cognitive decline, speech difficulty, aphasia, gait impairment).
ENDPOINTS	The primary efficacy endpoint was a composite of treatment failure defined as recurrent or residual SDH ≥10 mm at 180 days; reoperation or surgical rescue within 180 days after intervention; or major disabling stroke, myocardial infarction, or death from any neurological cause within 180 days after intervention. The primary safety endpoint was a composite of major disabling stroke or death from any cause within 30 days from intervention.

The SQUID Trial for the Embolization of the Middle Meningeal Artery for Treatment of Chronic Subdural Hematoma - STEM

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