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  • Treatment outcomes for ARUBA-eligible brain arteriovenous malformations: a comparison of real-world data from the NVQI-QOD AVM registry with the ARUBA trial

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Hemorrhagic stroke
Original research
Treatment outcomes for ARUBA-eligible brain arteriovenous malformations: a comparison of real-world data from the NVQI-QOD AVM registry with the ARUBA trial
  1. Anas Alrohimi1,2,
  2. Rebecca L Achey1,
  3. Nicolas Thompson3,
  4. Ramez N Abdalla4,
  5. Thomas Patterson1,
  6. Yasaman Moazeni4,
  7. Peter A Rasmussen1,
  8. Gabor Toth1,
  9. Mark D Bain1,
  10. Sameer A Ansari4,
  11. Shazam M Hussain1,
  12. Nina Z Moore1
  13. NVQI-QOD Registry Investigators
    1. 1Cerebrovascular Center, Departments of Neurology and Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
    2. 2Department of Medicine (Neurology), King Saud University, Riyadh, Riyadh Province, Saudi Arabia
    3. 3Department of Quantitative Health Sciences (NRT), Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
    4. 4Department of Radiology, Neurology, and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
    1. Correspondence to Dr Nina Z Moore, Cleveland Clinic Foundation, Cleveland, USA; mooren4{at}ccf.org

    Abstract

    Background Significant controversy exists about the management of unruptured cerebral arteriovenous malformations (AVMs). Results from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that intervention increases the risk of stroke/death compared with medical management. However, numerous study limitations raised concerns about the trial’s generalizability.

    Objective To assess 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 (25–722.5) 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' 5-year period (P=0.087). Additionally, when compared with 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 score ≥2 25.4% vs 46.2%; P<0.01).

    Conclusion Our results suggest that intervention for unruptured brain AVMs at comprehensive stroke centers across the United States is safe.

    • Arteriovenous Malformation
    • Stroke
    • Intervention

    Data availability statement

    No data are available. The NVQI database is not publicly available.

    https://doi.org/10.1136/jnis-2023-020525

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      Data availability statement

      No data are available. The NVQI database is not publicly available.

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      Footnotes

      • Twitter @Anas_AlRohimi, @prasmussenmd, @GaborTothMD

      • Collaborators Authorship and collaborator appendix will be generated and provided in accordance with the NVQI-QOD Governance Council rules and regulations.

        NVQI-QOD Registry Investigators: Mark Bain, Shazam Hussain, Ajit Krishnaney, Varun Kshettry, Thomas Masaryk, Nina Moore, Gabor Toth, Naser Jaleel, Itay Melamed, Clemens Schirmer, Gregory Weiner, Andrew DeNardo, Charles Kulwin, Troy Payner, Jodi Smith, Jacques Morcos, Eric Peterson, Robert Starke, Dileep Yavagal, Rishi Gupta, Amin Aghaebrahim, Ricardo Hanel, Eric Sauvageau, Brad Bohnstedt, Aaron Cohen-Gadol, Jerry Kovoor, Jesse Savage, Mitesh Shah, Avi Mazumdar, Dhruvil Pandya, Harish Shownkeen, Babak Jahromi, Martin Baggenstos, Vivek Deshmukh, Jane Ng, John Thiesing, Frederick Vincent, Todd Peebles, Geoffrey Colby, Gary Duckwiler, Aria Fallah, Reza Jahan, Gregory Lekovic, May Nour, Viktor Szeder, Anthony Wang, Paul Mazaris, Justin Singer, Mohamed Somji, Yince Loh, Cameron McDougall, Stephen Monteith, Akshal Patel, Zane Tymchak, Narlin Beaty, Matthew Lawson, T. Adam Oliver, Samuel Barnett, John Barr, Rafael de Oliveira Sillero, Roberta Novakovic, Glenn Pride, Christopher Taylor, Babu Welch, Bradley Weprin, Johnathan White, Dorothea Altshul, Breehan Chancellor, Anthony D’Ambrosio, Jonathan Yun, Ali Alaraj, Sepideh Amin-Hanjani, Gursant Atwal, Fady Charbel, David Dornbos, Justin Fraser, John Reavey-Cantwell, Dennis Rivet, Anil Roy, Jeffrey Thomas.

      • Contributors RLA, AA, NT: trial design, writing, statistical analyses, editing. RNA, YM, PAR, MB, GT, SAA, SMH: trial design, editing. TP: data analysis, editing. NM: trial conception, design, writing, editing, guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.