Statins in Patients Undergoing Primary Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Propensity-matched Study in the Trinetx Analytics Network

Introduction: Chronic subdural hematoma (cSDH) is a common neurosurgical disorder. Although there is evidence that statins improve the resolution of chronic subdural hematomas (cSDH), their interaction with middle meningeal artery (MMA) embolization is still unknown.

Methods: 630 cases were queried utilizing the TriNetX Analytics Network from 71 health care organizations. We included patients ≥18 years old with cSDH (ICD-10:I62.03, I62.00) who underwent MMA embolization but not surgical evacuation within 1 month of diagnosis. Other embolization indications were excluded. We separated patients into those taking any statin 2 months before or after embolization and those who never had taken any statin. Analyses of 3-year outcomes were performed after propensity score matching, controlling for baseline characteristics, medications, lab values, comorbidities, care provider and wheelchair dependence.

Results: A total of 630 patients were available for initial comparisons. The statin cohort consisted of 389 patients with mean age 74.0±10.9 and 26.7% females. The no-statin cohort consisted of 241 patients with mean age 68.0±16.6 and 34.9% females. A total of 171 patients were included in each cohort after propensity matching. Mortality was lower in the statin cohort (10.5% vs 20.5%, p=0.011), whereas functional/provider dependence (6.4% vs 11.1%, p=0.126) and headaches (13.5% vs 14.6%, p=0.756) were similar between the two cohorts. All other outcomes occurred in up to 10 patients and were reported as 0 or 10, precluding meaningful comparisons. Facial weakness and blindness and low vision occurred in 1–10 (0.6–5.8%) patients in each cohort. Repeat surgical evacuation occurred in 1–10 (0.6–5.8%) patients only in the statin cohort.

Conclusion : This national database analysis of 342 propensity-matched patients provides evidence that statin therapy may reduce mortality after MMA embolization for cSDH.