Superficial temporal artery retrograde access for the treatment of chronic subdural hematomas

Abstract

Objective: Middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) has ushered in a treatment paradigm shift. The objective of this study was to determine whether the superficial temporal artery (STA) could be used consistently and just as effectively compared to conventional femoral and radial artery access.

Methods: The authors retrospectively reviewed a series of consecutive cases from January 1, 2024, to February 28, 2025, where the STA was used to treat cSDH. The 90-day readmission, retreatment, and death rates were collected and compared against a set of internal comparison cases that underwent similar treatment, though via femoral or radial artery puncture.

Results: The study included 40 patients with STA retrograde (STAR) access and 50 patients who had traditional transfemoral or radial artery approaches. In the STA group, there was significantly reduced radiation exposure (p < 0.001) and less contrast administration (p < 0.001). There were no differences between the groups in terms of the 90-day readmission (p = 0.82), retreatment (p = 0.93), or death rates (p = 0.42). One access site complication was observed after a transfemoral intervention.

Conclusions: STAR access is an alternative for MMA embolization in cSDH. This innovative approach can potentially rival the results achieved by traditional techniques.

Keywords: endovascular; middle meningeal artery embolization; minimally invasive; novel; subdural hematoma; superficial temporal artery.