- Among patients with unruptured brain arteriovenous malformations (AVMs), medical management carries a 69% lower risk for death or symptomatic stroke at ~4 years when compared with interventional therapy.
Why this matters
- Uncertainty has persisted regarding the longer-term benefits and risks of the 2 treatment strategies.
- Editorial mentions disappointment that the U.S. government declined to fund the trial’s 5-year follow-up but notes the similarity of the current findings with long-term outcomes data from an ongoing population-based observational study.
- During a mean 50.4-month follow-up, medical management vs interventional therapy yielded lower risk for death or symptomatic stroke:
- Incidence: 3.39 vs 12.32 per 100 patient-years.
- HR: 0.31 (95% CI, 0.17-0.56).
- Risk for death was nonsignificantly lower (HR, 0.49; 95% CI, 0.09-2.67).
- Of 4 deaths in the interventional therapy group, 2 were attributed to the intervention.
- The medical management group had a lower risk for adverse events:
- Incidence: 58.97 vs 78.73 per 100 patient-years.
- Risk difference: −19.76 (95% CI, −30.33 to −9.19).
- Extended follow-up of an international randomized controlled trial among 226 adults with unruptured brain AVMs (ARUBA trial):
- Medical management (pharmacologic therapy for neurologic symptoms as needed) alone vs
- Medical management plus interventional therapy (neurosurgery, embolization, and/or stereotactic radiotherapy).
- Trial stopped early, at mean 33.3-month follow-up, because of superiority of medical management alone.
- Main outcome: death or symptomatic stroke.
- Funding: National Institute of Neurological Disorders and Stroke; Vital Projects Fund.
- Limited power because of early enrollment cessation.
- Shortened follow-up because of lack of funding.