The trial is taking place at:

Baptist Health | Research Institute

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




Active, not recruiting


Subdural Hematoma, Chronic


Procedure: Surgical Evacuation
Device: SQUID Embolization and Surgical Evacuation
Device: SQUID Embolization
Other: Other: Medical Management

Study type


Funder types




Details and patient eligibility


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)

Full description

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).


310 estimated patients




30+ years old


No Healthy Volunteers

Inclusion criteria

  • Male or female Subject whose age is ≥ 30 at the time of consent
  • Pre-morbid mRS 0-1 within the previous 12 months
  • cSDH measures ≥ 10 mm in greatest thickness
  • cSDH exerts mass effect upon the subjacent brain, as indicated by local cortical flattening or midline shift
  • 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))
  • 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
  • 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
  • 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
  • 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

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

Trial design

Primary purpose




Interventional model

Parallel Assignment


Single Blind

310 participants in 2 patient groups

Experimental group
Embolization of the Middle Meningeal Artery (MMA)
Device: SQUID Embolization
Device: SQUID Embolization and Surgical Evacuation
No Embolization
Active Comparator group
Standard Management
Other: Other: Medical Management
Procedure: Surgical Evacuation

Trial contacts and locations



Central trial contact

Richelle Massey; Amanda Johnson

Data sourced from

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