Intervention for Unruptured Brain AVMs Proves Very Harmful in the Short Term

Hooman Kamel, MD

In a randomized trial, interventions to obliterate unruptured arteriovenous malformations led to considerably more short-term morbidity and mortality than conservative treatment.

Brain arteriovenous malformations (AVMs) can rupture and cause disabling or lethal intracerebral hemorrhage. For already-ruptured AVMs, interventions such as surgical resection, radiotherapy, endovascular embolization, or a combination of these are widely accepted because of the high risk for recurrent hemorrhage. However, the advisability of intervention for unruptured AVMs is controversial. Investigators now report the results of A Randomized trial of Unruptured Brain Arteriovenous malformations (ARUBA), the first randomized trial of intervention versus conservative therapy for unruptured AVMs. The researchers enrolled adults with untreated AVMs that were amenable to intervention and showed no radiographic evidence of previous hemorrhage. All enrolled patients received medical management of symptoms such as headache or seizures. Half were randomly assigned to receive an intervention to obliterate the AVM, with the interventional treatment plan chosen by an experienced multidisciplinary team at each study site.

After 226 patients were enrolled, further enrollment was halted because the primary outcome of death or symptomatic stroke occurred significantly more often in the intervention arm (30.7%) than in the control arm (10.1%). Among patients with at least 30 months of follow-up, the rate of disability (modified Rankin Scale score ≥2) was significantly higher in the intervention group than in the conservative-management group (46.2% vs. 15.1%).

Citation(s):

Mohr JP et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): A multicentre, non-blinded, randomised trial. Lancet 2013 Nov 20.