Will A Randomized Trial of Unruptured Brain Arteriovenous Malformations Change Our Clinical Practice?

L Pierot,C Cognard,L Spelle,J Fiehler,M Söderman

doi:10.3174/ajnr.a3867

Abstract

A Randomized Trial of Unruptured Brain Arteriovenous malformations (ARUBA) was stopped on April 15, 2013, because of the superiority of the medical management group.[1][1] We congratulate the ARUBA investigators for designing this trial and being able to include 223 patients. The ARUBA study was

Highlights

The ARUBA study was designed to determine whether medical management is superior or noninferior to interventional therapy for the prevention of the composite outcome of death from any cause or symptomatic stroke in the management of unruptured brain arteriovenous malformations, and whether it decreases the risk of death or clinical impairment at 5-year postrandomization
The primary end point was reached in 10% of patients in the medical management group and in 31% in the interventional therapy group
For unruptured brain arteriovenous malformations (bAVMs), the strategy of treatment is a matter of debate because the balance between therapeutic risks and the risk of natural history is difficult to determine and is dependent on several factors, including the ones mentioned above.[2,5]

Summary

Introduction

The ARUBA study was designed to determine whether medical management is superior or noninferior to interventional therapy for the prevention of the composite outcome of death from any cause or symptomatic stroke in the management of unruptured brain arteriovenous malformations (bAVMs), and whether it decreases the risk of death or clinical impairment (modified Rankin Scale score of Ն2) at 5-year postrandomization. Brain AVMs represent a very heterogeneous group with regard to clinical presentation (hemorrhage, seizures, headache, focal neurologic deficit), anatomic characteristics (feeding arteries, nidus, draining veins), and modalities of treatment (surgery, radiation therapy, embolization, or combination of modalities).[2,3,4] For unruptured bAVMs, the strategy of treatment is a matter of debate because the balance between therapeutic risks and the risk of natural history is difficult to determine and is dependent on several factors, including the ones mentioned above.[2,5]

Results

Conclusion