Increase in Ruptured Cerebral Arteriovenous Malformations and Mortality in the United States: Unintended Consequences of the ARUBA Trial?

BackgroundThe findings of the ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformation) trial, which determined that medical management was superior to prophylactic interventional therapy for the treatment of unruptured cerebral arteriovenous malformations (cAVMs), remain polarizing...

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Bibliographic Details
Published in:Stroke: vascular and interventional neurology 2023-01, Vol.3 (1)
Main Authors: Dicpinigaitis, Alis J., Ogulnick, Jonathan V., Mayer, Stephan A., Gandhi, Chirag D., Al‐Mufti, Fawaz
Format: Article
Language:English
Subjects:
Aneurysms
arteriovenous malformation
Mortality
rupture
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Summary:BackgroundThe findings of the ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformation) trial, which determined that medical management was superior to prophylactic interventional therapy for the treatment of unruptured cerebral arteriovenous malformations (cAVMs), remain polarizing and controversial.MethodsAdult cAVM patient admissions were identified in the National Inpatient Sample from 2009 to 2019. The incidence of cAVM rupture and in‐hospital mortality were compared between the pre‐ (2009–2013) and post‐ARUBA trial eras (2014–2019) using complex samples‐weighted estimates and multivariable logistic regression analyses. A control cohort composed of an alternate pathology (ruptured and unruptured cerebral aneurysms) was also assessed during the study period to evaluate potential bias.ResultsAmong 121 415 hospitalizations for cAVM during the study period, 31 389 (25.9%) were admissions for ruptured malformations. The incidence of ruptured cAVM increased in the post‐ARUBA trial era (13.3% versus 34.4%; P
ISSN:2694-5746
2694-5746
DOI:10.1161/SVIN.122.000442