The CHALLENGER Registry

The NumenFR detachment system is a sterile, handheld, single-patient use device designed for use with the Numen SILK coil embolization system and is operated by two pre-loaded batteries. The analysis of the Numen SILK coil embolization system will occur prospectively if it is determined the patient meets the enrollment criteria. All patients enrolled in the study will receive supportive and medical treatment by choice of the treating physician and in accordance with standard of care. Such treatment includes but is not limited to: neurointensive care, neuromonitoring, and surgical and medical management of cSDH.

• Age 18-98 years inclusively
• Per CT of the head, (one of the following):

• Unilateral convexity cSDH measuring at least 10 mm in thickness OR
• Bilateral cSDH if only one side is considered for treatment and the contralateral side is asymptomatic and < 5 mm in thickness.
• cSDH at least 2/3 isodense or hypodense, verified on axial CT slice used to measure the thickness of the qualifying cSDH
• Qualifying baseline head CT performed within the 14 days prior to treatment
• Patient or legally authorized representative agrees to be participated in the study and provides written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization

Exclusion criteria

• Secondary cause apart from trauma for the qualifying SDH, such as an underlying vascular abnormality or tumor
• Bilateral cSDH with unknown origin of symptoms
• Participants who underwent prior embolization of either MMA
• Tentorial or interhemispheric SDH
• mRS >4
• On tranexamic acid
• Intractable coagulation dysfunction or abnormal platelet count and function (pre-operative International Normalized Ratio [INR] > 1.5 and/or platelet count < 80109/L)
• Anatomical variations that may affect the safety of MMA embolization (e.g., prominent middle MMA ophthalmic artery anastomosis)
• Known contraindications to angiography
• Known intolerance to occlusion procedures
• Known vascular anatomy (small artery size) or blood flow (high vascular resistance peripheral to the feeding arteries) that precludes catheter placement or coil embolization
• Known presence of collateral vessel pathways potentially endangering normal territories or cranial nerves during embolization.
• Known large diameter arteriovenous shunt, i.e., where the blood does not pass through an arterial/capillary/venous transition but directly from an artery to a vein or presence of patent extra-to-intracranial anastomoses (where study embolization devices could pass directly into the internal carotid artery, vertebral artery, or intracranial vasculature) that cannot be addressed with coil embolization.
• Patient has a known active systemic infection or sepsis
• Patient is pregnant, planning to become pregnant, or lactating
• Life expectancy of less than 6 months due to comorbid terminal conditions
• Concurrent participation in another research protocol for investigation of an experimental therapy
• Known or suspected to not be able to comply with the study protocol