Introduction Significant controversy exists in the management of unruptured cerebral arteriovenous malformations (AVM). Results from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that intervention increases the risk of stroke/death compared to medical management. However, numerous study limitations raised concerns regarding the trial’s generalizability. We assessed the rate of stroke/death and functional outcomes in ARUBA-eligible patients from a multicenter database, the Neurovascular Quality Initiative Quality Outcomes Database (NVQI-QOD).
Methods We performed a retrospective analysis of prospectively-collected data of ARUBA-eligible patients who underwent intervention at 18 participating centers. The primary endpoint was stroke/death from any cause. Secondary endpoints included neurologic, systemic, radiographic, and functional outcomes.
Results 173 ARUBA-eligible patients underwent intervention with median follow-up of 269 (25-733) days. Seventy-five patients received microsurgery ± embolization, 37 received radiosurgery, and 61 received embolization. Baseline demographics, risk factors, and general AVM characteristics were similar between groups. A total of 15 (8.7%) patients experienced stroke/death with no significant difference in primary outcome between treatment modalities. Microsurgery ± embolization was more likely to achieve AVM obliteration (P < 0.001). Kaplan-Meier survival curves demonstrated no difference in overall death/stroke outcomes between the different treatment modalities (P = 0.146). Additionally, when compared to the ARUBA interventional arm, our patients were significantly less likely to experience death/stroke (8.7% vs. 30.7%; P < 0.001) and functional impairment (mRS ≥ 2) (17% vs. 46.2%; P < 0.001).
Conclusion Our results suggest that intervention for unruptured brain AVMs at specialized centers across the United States is safe and effective.
Disclosures A. Alrohimi: None. R. Achey: None. R. Abdalla: None. T. Patterson: None. Y. Moazeni: None. P. Rasmussen: None. G. Toth: None. M. Bain: None. S. Ansari: None. S. Hussain: None. N. Moore: None.
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