Puerto Rico Embolization of the Middle Meningeal Artery for the Treatment of Chronic Subdural Hematoma Trial (PREMMA)

Inclusion Criteria: * Age ≥ 21 * Speak and understand Spanish or English * Resident of Puerto Rico * Glasgow coma scale ≥ 14/15 * Presence of cSDH on non-contrast computed tomography (NCCT) or magnetic resonance imaging (MRI) * Neurological indication for treatment of cSDH (Markwalder scale ≤ 2) * No previous surgical or endovascular treatment for symptomatic cSDH * Signed informed consent for participation in the study by the patient or legally authorized representative Exclusion Criteria: * Acute subdural hematoma * Focal, non-hemispheric localization of cSDH * Evidence of other lesions associated with cSDH, such as neoplasms, vascular lesions, or additional epidural, subarachnoid, or parenchymal hemorrhage on non-contrast computed tomography or magnetic resonance imaging * Imaging evidence of skull fracture over the subdural hematoma * Presence of any cerebrospinal fluid (CSF) shunt * Imaging evidence of midline shift ≥ 10 mm * Imaging evidence of basal cistern effacement * Imaging evidence of dilatation of lateral ventricles * Imaging evidence of uncal herniation * Modified Rankin scale ≥ 3 before developing symptoms associated with cSDH * Contraindications for angiography (i.e., complex anatomy or kidney failure) * Comorbidity making follow-up impossible * Pregnancy * Vulnerable patients, including homeless patients, incarcerated patients, and mentally ill patients without appropriate medical decision-making proxies that the physician believes are incapable of appropr…