Multimodal Interventional Treatment and Outcomes for Unruptured Arteriovenous Malformations
Background. This study aimed to evaluate the selection and outcomes of multimodal interventional treatment for unruptured brain arteriovenous malformations (uAVMs) in ARUBA-eligible patients in a single institution.
Methods. We retrospectively reviewed the data of 94 patients with uAVMs treated between 2002 and 2014. They were divided into an intervention group and a conservative group. The primary outcome was defined as the composite of death or symptomatic stroke. Functional outcome was assessed using the modified Rankin Scale (mRS).
Results. The intervention and conservative groups included 75 and 19 patients, respectively, with mean follow-up periods of 59.2 ± 41.6 and 72.8 ± 39.2 months (P = 0.20), among whom the primary outcome occurred in 9 (12.3%) and 3 (17.6%) patients, respectively (P = 0.91). The proportion of patients with an mRS score ≥ 2 at last follow-up was not significantly different between the two groups (6.9% vs. 11.7%). In the intervention group, the incidence of death or stroke was lower and functional outcomes were better among patients with grade I/II AVMs than among patients with grade III AVMs.
Conclusion. For patients with uAVMs, interventional treatment is not inferior to medical treatment alone, and careful selection should be made for patients with grade III AVMs.
KeywordsARUBA Interventional therapy Medical management Stroke Unruptured brain arteriovenous malformation
Compliance with Ethical Standards
Conflicts of interest: The authors declare that they have no conflict of interest.
Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
- 1.Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Al-Shahi Salman R, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJ, Harkness K, Libman R, Barreau X, Moskowitz AJ. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383:614–21.CrossRefGoogle Scholar
- 3.Magro E, Gentric JC, Darsaut TE, Ziegler D, Bojanowski MW, Raymond J. Responses to ARUBA: a systematic review and critical analysis for the design of future arteriovenous malformation trials. J Neurosurg. 2016;29:1–9.Google Scholar
- 5.Nerva JD, Mantovani A, Barber J, Kim LJ, Rockhill JK, Hallam DK, Ghodke BV, Sekhar LN. Treatment outcomes of unruptured arteriovenous malformations with a subgroup analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible patients. Neurosurgery. 2015;76:563–70.CrossRefGoogle Scholar
- 8.Steiger HJ, Fischer I, Rohn B, Turowski B, Etminan N, Hanggi D. Microsurgical resection of Spetzler-Martin grades 1 and 2 unruptured brain arteriovenous malformations results in lower long-term morbidity and loss of quality-adjusted life-years (QALY) than conservative management—results of a single group series. Acta Neurochir. 2015;157:1279–87.CrossRefGoogle Scholar