OBJECT: Management of unruptured arteriovenous malformations (AVMs) is controversial. In the first randomized trial of unruptured AVMs (A Randomized Trial of Unruptured Brain Arteriovenous Malformations [ARUBA]), medically managed patients had a significantly lower risk of death or stroke and had better outcomes. The University of California, San Francisco (UCSF) was one of the participating ARUBA sites. While 473 patients were screened for eligibility, only 4 patients were enrolled in ARUBA. The purpose of this study is to report the treatment and outcomes of all ARUBA-eligible patients at UCSF. METHODS: The authors compared the treatment and outcomes of ARUBA-eligible patients using prospectively collected data from the UCSF brain AVM registry. Similar to ARUBA, they compared the rate of stroke or death in observed and treated patients and used the modified Rankin Scale to grade outcomes. RESULTS: Of 74 patients, 61 received an intervention and 13 were observed. Most treated patients had resection with or without preoperative embolization (43 [70.5%] of 61 patients). One of the 13 observed patients died after AVM hemorrhage. Nine of the 61 treated patients had a stroke or died. There was no significant difference in the rate of stroke or death (HR 1.34, 95% CI 0.12-14.53, p = 0.81) or clinical impairment (Fisher's exact test, p > 0.99) between observed and treated patients. CONCLUSIONS: The risk of stroke or death and degree of clinical impairment among treated patients was lower than reported in ARUBA. The authors found no significant difference in outcomes between observed and treated ARUBA-eligible patients at UCSF. Results in ARUBA-eligible patients managed outside that trial led to an entirely different conclusion about AVM intervention, due to the primary role of surgery, judicious surgical selection with established outcome predictors, and technical expertise developed at high-volume AVM centers.
RCT Entities:
OBJECT: Management of unruptured arteriovenous malformations (AVMs) is controversial. In the first randomized trial of unruptured AVMs (A Randomized Trial of Unruptured Brain Arteriovenous Malformations [ARUBA]), medically managed patients had a significantly lower risk of death or stroke and had better outcomes. The University of California, San Francisco (UCSF) was one of the participating ARUBA sites. While 473 patients were screened for eligibility, only 4 patients were enrolled in ARUBA. The purpose of this study is to report the treatment and outcomes of all ARUBA-eligible patients at UCSF. METHODS: The authors compared the treatment and outcomes of ARUBA-eligible patients using prospectively collected data from the UCSF brain AVM registry. Similar to ARUBA, they compared the rate of stroke or death in observed and treated patients and used the modified Rankin Scale to grade outcomes. RESULTS: Of 74 patients, 61 received an intervention and 13 were observed. Most treated patients had resection with or without preoperative embolization (43 [70.5%] of 61 patients). One of the 13 observed patients died after AVM hemorrhage. Nine of the 61 treated patients had a stroke or died. There was no significant difference in the rate of stroke or death (HR 1.34, 95% CI 0.12-14.53, p = 0.81) or clinical impairment (Fisher's exact test, p > 0.99) between observed and treated patients. CONCLUSIONS: The risk of stroke or death and degree of clinical impairment among treated patients was lower than reported in ARUBA. The authors found no significant difference in outcomes between observed and treated ARUBA-eligible patients at UCSF. Results in ARUBA-eligible patients managed outside that trial led to an entirely different conclusion about AVM intervention, due to the primary role of surgery, judicious surgical selection with established outcome predictors, and technical expertise developed at high-volume AVM centers.
Entities:
Keywords:
ARUBA; ARUBA = A Randomized Trial of Unruptured Brain Arteriovenous Malformations; AVM = arteriovenous malformation; UCSF = University of California, San Francisco; arteriovenous malformation; mRS = modified Rankin Scale; microsurgical resection; observation
Authors: C Stapf; H Mast; R R Sciacca; J H Choi; A V Khaw; E S Connolly; J Pile-Spellman; J P Mohr Journal: Neurology Date: 2006-05-09 Impact factor: 9.910
Authors: Jae H Choi; Henning Mast; Robert R Sciacca; Andreas Hartmann; Alexander V Khaw; Jay P Mohr; Ralph L Sacco; Christian Stapf Journal: Stroke Date: 2006-04-13 Impact factor: 7.914
Authors: L D Lunsford; D Kondziolka; J C Flickinger; D J Bissonette; C A Jungreis; A H Maitz; J A Horton; R J Coffey Journal: J Neurosurg Date: 1991-10 Impact factor: 5.115
Authors: Michael Kerin Morgan; Andrew Michael Rochford; Antonio Tsahtsarlis; Nicholas Little; Kenneth Charles Faulder Journal: Neurosurgery Date: 2004-04 Impact factor: 4.654
Authors: Alexander X Halim; S Claiborne Johnston; Vineeta Singh; Charles E McCulloch; John P Bennett; Achal S Achrol; Stephen Sidney; William L Young Journal: Stroke Date: 2004-05-27 Impact factor: 7.914
Authors: Ahmed J Awad; Brian P Walcott; Christopher J Stapleton; Dale Ding; Cheng-Chia Leed; Jay S Loeffler Journal: J Clin Neurosci Date: 2015-04-23 Impact factor: 1.961
Authors: A I Qureshi; O Saeed; S Sahito; I Lobanova; J Liaqat; F Siddiq; C R Gomez Journal: AJNR Am J Neuroradiol Date: 2020-02-27 Impact factor: 3.825
Authors: Ali Tayebi Meybodi; Helen Kim; Jeffrey Nelson; Steven W Hetts; Timo Krings; Karel G terBrugge; Marie E Faughnan; Michael T Lawton Journal: Neurosurgery Date: 2018-01-01 Impact factor: 4.654
Authors: Runlin Yang; Yifan Ren; Julian Maingard; Vincent Thijs; Dustin Viet Anh Le; Hong Kuan Kok; Michael J Lee; Joshua A Hirsch; Ronil V Chandra; Duncan Mark Brooks; Hamed Asadi Journal: Brain Circ Date: 2021-05-29