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

NCT ID: NCT04410146

Last Updated: 2025-04-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

310 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-01

Study Completion Date

2024-05-23

Brief Summary

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STEM Study is a pivotal, international, multi-center, prospective, randomized (1:1) controlled trial designed to provide an assessment of the safety and effectiveness of Middle Meningeal Artery (MMA) embolization with SQUID for the management of Chronic Subdural Hematoma (cSDH)

Detailed Description

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The study objective is to provide an assessment of the safety and effectiveness of Middle Meningeal Artery (MMA) embolization with SQUID for the management of Chronic Subdural Hematoma (cSDH).

Conditions

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Subdural Hematoma, Chronic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Cognitive improvement, as measured by blinded assessment, utilizing the comprehensive neurocognitive battery.

Imaging assessment by blinded core laboratory

Study Groups

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SQUID

Embolization of the Middle Meningeal Artery (MMA)

Group Type EXPERIMENTAL

SQUID Embolization

Intervention Type DEVICE

Embolization of the Middle Meningeal Artery using the SQUID non-adhesive liquid embolic agent

SQUID Embolization and Surgical Evacuation

Intervention Type DEVICE

Embolization of the Middle Meningeal Artery using the SQUID non-adhesive liquid embolic agent and the surgical evacuation of the sub-dural hematoma

No Embolization

Standard Management

Group Type ACTIVE_COMPARATOR

Surgical Evacuation

Intervention Type PROCEDURE

Surgical evacuation of the sub-dural hematoma

Other: Medical Management

Intervention Type OTHER

Standard

Interventions

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SQUID Embolization

Embolization of the Middle Meningeal Artery using the SQUID non-adhesive liquid embolic agent

Intervention Type DEVICE

SQUID Embolization and Surgical Evacuation

Embolization of the Middle Meningeal Artery using the SQUID non-adhesive liquid embolic agent and the surgical evacuation of the sub-dural hematoma

Intervention Type DEVICE

Surgical Evacuation

Surgical evacuation of the sub-dural hematoma

Intervention Type PROCEDURE

Other: Medical Management

Standard

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Male or female Subject whose age is ≥ 30 at the time of consent
2. Pre-morbid mRS 0-1 within the previous 12 months
3. cSDH measures ≥ 10 mm in greatest thickness
4. cSDH exerts mass effect upon the subjacent brain, as indicated by local cortical flattening or midline shift
5. Imaging characteristics indicative of chronicity (≥ 50% of the volume of the collection should be isodense or hypodense to normal cortical gray matter on Computed Tomography (CT))
6. Subject presents with one or more of the following neurological symptoms: headache; cognitive decline; speech difficulty or aphasia; gait impairment or imbalance; focal neurological deficit (weakness, paresthesia or sensory deficit involving of one or more extremities or facial droop); and/or seizure
7. Subject, or his/her legally authorized representative, understands the nature of the procedure, consents to participation in the study and provides a signed Informed Consent Form
8. Female Subjects of child-bearing potential must be able to provide a current negative urine pregnancy test and agree to an appropriate method of contraception throughout the trial
9. Subject is able and willing to return to the investigational site for all follow-up visits (e.g., 30-day, 90-day, 180-day and 1-year), as required per protocol

Exclusion Criteria

1. Subject with prior ipsilateral craniotomy or burr hole evacuation of cSDH
2. Subject with prior Embolization of either MMA
3. Subject requires (in the opinion of the treating surgeon) a full or mini craniotomy
4. Subject with urgent or emergent (within 1 hour of assessment) subdural hematoma evacuation needed
5. Subject with a cSDH with a focal location (confined to the frontal or temporal base or the inter-hemispheric space without cerebral convexity involvement)
6. cSDH developed due to underlying condition such as a vascular lesion, brain tumor, arachnoid cyst, spontaneous intracranial hypotension or secondary to a previous craniotomy
7. Life expectancy of \<1 year
8. Subject who presents with an intracranial mass other than subdural hematoma
9. Subject who presents with a meningioma with mass effect and/or ≥1 cm or currently undergoing radiation therapy for carcinoma or sarcoma of the head or neck region
10. Subject with serum creatinine level \> 3.0 mg/dL at time of enrollment (this will restrict the use of contrast) and not on dialysis
11. Subject with significant liver function impairment at the time of enrollment
12. Subject with a life-threatening allergy to radiographic contrast (unless treatment for allergy is tolerated or can be managed medically)
13. Subject who is currently enrolled in another investigational study protocol that could potentially confound the current study endpoints
Minimum Eligible Age

30 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Balt USA

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David Fiorella, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Stony Brook University Medical Center

Adam Arthur, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Semmes-Murphy Neurologic and Spine Institute

Locations

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Barrow Neurological Institute

Phoenix, Arizona, United States

Site Status

Carondolet St. Joseph's

Tucson, Arizona, United States

Site Status

Riverside Community Hospital

Riverside, California, United States

Site Status

Santa Barbara Cottage Hospital

Santa Barbara, California, United States

Site Status

Los Robles Hospital and Medical Center

Thousand Oaks, California, United States

Site Status

Swedish Medical Center

Englewood, Colorado, United States

Site Status

Baptist Health

Jacksonville, Florida, United States

Site Status

Emory University

Atlanta, Georgia, United States

Site Status

Wellstar Kennestone Hospital

Marietta, Georgia, United States

Site Status

University of Kansas

Kansas City, Kansas, United States

Site Status

Johns Hopkins Medicine

Baltimore, Maryland, United States

Site Status

Nebraska Health

Omaha, Nebraska, United States

Site Status

Overlook Medical Center

Summit, New Jersey, United States

Site Status

NYU Langone Health

New York, New York, United States

Site Status

Stony Brook University

Stony Brook, New York, United States

Site Status

Montefiore Medical Center

The Bronx, New York, United States

Site Status

Geisinger Medical Center

Danville, Pennsylvania, United States

Site Status

Penn State Health Hershey Medical Center

Hershey, Pennsylvania, United States

Site Status

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status

Rhode Island Hospital

Providence, Rhode Island, United States

Site Status

Methodist University Hospital

Memphis, Tennessee, United States

Site Status

Baptist Memorial Hospital

Memphis, Tennessee, United States

Site Status

University of Utah

Salt Lake City, Utah, United States

Site Status

Swedish Cherry Hill

Seattle, Washington, United States

Site Status

West Virginia University

Morgantown, West Virginia, United States

Site Status

Chu Cote de Nacre

Caen, , France

Site Status

CHU Hopital Bicetre

Le Kremlin-Bicêtre, , France

Site Status

Hopital Pitie Salpetriere

Paris, , France

Site Status

CHU Hopital Maison Blanche

Reims, , France

Site Status

Universitätsklinikum Heidelberg

Heidelberg, , Germany

Site Status

Klinikum Nurnberg Sud

Nuremberg, , Germany

Site Status

Gregorio Maranon Hospital

Madrid, , Spain

Site Status

Countries

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United States France Germany Spain

References

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Fiorella D, Monteith SJ, Hanel R, Atchie B, Boo S, McTaggart RA, Zauner A, Tjoumakaris S, Barbier C, Benitez R, Spelle L, Pierot L, Hirsch JA, Froehler M, Arthur AS; STEM Investigators. Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma. N Engl J Med. 2025 Feb 27;392(9):855-864. doi: 10.1056/NEJMoa2409845. Epub 2024 Nov 20.

Reference Type DERIVED
PMID: 39565980 (View on PubMed)

Other Identifiers

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CIP-201912-SQUID

Identifier Type: -

Identifier Source: org_study_id

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