Arteriovenous Malformations (AVMs)

FACTS

 

HPI

 

PHYSICAL EXAM

IMAGING

 
A/P

ARUBA (A Randomized Trial of Unruptured AVMs)

  • Design: RCT
  • Population: 226 patients with un-ruptured brain AVMs
  • Arms
    • Medical management alone (control)
    • Interventional therapy (surgery, embolization, radio-surgery, or a combination)
  • Median follow-up: ~33 months (trial was stopped early)
  • Outcome measured: Composite of death or symptomatic stroke (ischemic or hemorrhagic).
  • Results
      • At median 33 months:
    • Medical group: 10.1% (N=11) had stroke or death
    • Intervention group: 30.7% (N=35) had stroke or death
    • Hazard ratio: 0.27 (95% CI 0.14–0.54, p < 0.001)
  • Criticism
    • Conclusion: Medical management is superior to interventional therapy in preventing death or stroke over short-term follow-up.
    • Caveat: The study did not address long-term hemorrhage risk, and follow-up was short for a lifelong disease like AVM.
    • The trial was stopped early, limiting assessment of long-term benefit from definitive obliteration
Takeaway: Medical management wins early, but long-term debate continues.