WSC 2025 | Findings from the EMMA-Can trial of embolization of middle meningeal artery for subdural hematoma

EMMA, as we call it, stands for embolization of middle meningeal artery, is a minimally invasive endovascular procedure that blocks the arterial supply to the membrane responsible for a chronic subdural hematoma. And it works by cutting off the blood flow into the inflammatory cycle. EMMA helps the hematoma resolve and then prevent recurrence. And both of those things are very important. It’s performed via a catheter-based embolization using liquid embolic agent like Onyx and has shown strong evidence of efficacy and safety as an adjunct to surgery in recent randomized control trial, including EMMA-CAN study. Over the last few years, embolization of middle meningeal artery, that is the EMMA, has emerged as a promising minimally invasive technique aimed at preventing these recurrences. It targets the tiny fragile vessels we talked about that perpetuate the hematoma cutting off their blood supply. The early randomized controlled trials published in New England Journal of Medicine and JAMA had mixed results, some showing clear benefit, while others did not. They also differ in design, patient selection, and endpoints. Our study was designed to provide a definitive, methodologically robust answer. It was conducted across multiple centers in Canada using blinded adjudication and standardized imaging to address previous limitations and to evaluate EMMA’s safety and efficacy. So what we found from our study is, like comparing to the other study, ours was the strongest and most methodologically rigorous evidence to date in chronic subdural hematoma management. Earlier trials, as I mentioned, had conflicting results. We found that EMMA reduced recurrence by nearly 70%, a 6.5-fold decrease compared with surgery alone, without increasing any adverse events. We have run also a parallel prospective registry, which will show how EMMA performed outside the strict confines of a trial, bridging the gap between efficacy and real-world effectiveness.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.