Abstract TP586: Rates and Predictors of Stroke in Medically Managed Patients With Unruptured Arteriovenous Malformations in ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)

Abstract

Background: Primary endovascular embolization has been advocated for treatment of brain arteriovenous malformations (BAVM) in recent trials. We performed this analysis to identify the rate and predictors of incident stroke in a cohort of unruptured BAVM patients recruited in a multicenter trial. Methods: We analyzed adult patients (≥18 years) with an unruptured BAVM were enrolled into Randomised trial of Unruptured Brain Arteriovenous malformations (ARUBA) at 39 clinical sites in nine countries who were randomized to medical treatment. We identified the rates of stroke ascertained by in-person neurological follow-up visits were performed at 6 month intervals during the first 2 years and annually, with telephone contacts every 6 months thereafter. The effect of baseline clinical and neuroimaging characteristics on incident stroke were determined. Results: A stroke event had occurred for 11 (10·1%) of the 109 patients randomized to medical management with a mean follow-up 33·3 months [SD 19·7]) with an annual incidence of 10.1%. Patients with unrelated intracranial aneurysms and higher systolic blood pressure were at higher risk. The mean systolic blood pressure was significantly higher among patients with stroke event (mean 142.3 ± SD 20.3 versus 124.8 ± 14.8, p=.03). There was a linear increase in the risk of stroke event with increasing systolic blood pressure in the logistic regression model (OR 1.1, 95% 1.0 - 1.11, p=.047) There was a trend towards lower incidence of stroke events in BAVM located in the occipital lobe (p=.099). Patient’s age, initial lesion size, and Spetzler Martin grade were not associated with stroke events. Conclusions: A low rate of stroke events was seen in patients with unruptured BAVM with the potential preventive role of aggressive systemic blood pressure treatment.