Arteriovenous Malformations: Difference between revisions

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ARUBA Trial Summary
Objective:<br />
The ARUBA trial aimed to determine whether medical management alone or combined with interventional therapy (neurosurgery, embolization, stereotactic radiotherapy) is better at preventing symptomatic stroke or death in patients with unruptured brain arteriovenous malformations (AVMs).
Methods:
<blockquote>[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image1.png]]Design: Multicenter, non-blinded, randomized controlled trial.
[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image2.png]]Participants: 226 adults with unruptured brain AVMs, randomized to either medical management alone (110 patients) or with interventional therapy (116 patients).
[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image3.png]]Duration: Mean follow-up of 50.4 months.
[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image4.png]]Primary Outcome: Time to death or symptomatic stroke confirmed by imaging.
</blockquote>
Results:
<blockquote>[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image5.png]]Incidence of Stroke/Death: Lower in the medical management group (3.39 per 100 patient-years) than in the interventional therapy group (12.32 per 100 patient-years).
[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image6.png]]Hazard Ratio: 0.31 (95% CI 0.17 to 0.56), favoring medical management alone.
[[File:vertopal_d8d13e0f529b4deda775bd404f976974/media/image7.png]]Adverse Events: Fewer in the medical management group.
</blockquote>
Conclusion:<br />
Medical management alone is superior to interventional therapy for preventing death or symptomatic stroke in patients with unruptured brain AVMs over a mean follow-up of about 4 years. These findings should guide clinical practice and patient counseling.
Funding:<br />
Funded by the National Institute of Neurological Disorders and Stroke (NINDS) and the Vital Projects Fund.
Reference
Mohr JP, et al. ARUBA trial: Medical vs. interventional therapy for unruptured brain AVMs. Lancet Neurol 2020; 19: 573–81.


[[Category:Vascular Pathology]]
[[Category:Vascular Pathology]]
[[Category:Cerebral Vascular Malformations]]
[[Category:Cerebral Vascular Malformations]]

Revision as of 01:38, 20 July 2024

Definition

  • Fistulous connections b/w cerebral arteries & veins w/o a nml capillary bed.

Clinical Presentation

  • Up to 40% present w/ unrelated Sx.
  • The remainder w/ Sx related to the AVM (focal deficit, H/A, sz)
    • These Sx may be assoc. w/ hemorrhage, mechanical compression, irritation
  • Medical attention in 50% due to ruptured AVM w/ hemorrhage (intraparenchymal MC, IVH, SDH, or SAH)

Subgroups of Presentation - Ruptured, Unruptured ( ± w/ microhemorrhages)

Hemorrhagic Presentation

  • Risk factors: Small size, deep location, exclusive deep venous drainage, and association with aneurysms.
  • Pts who initially presents w/ hemorrhage, have a high risk of rehemorrhage (20%–40%).
    • The highest risk is w/i the first yr.

Seizures as a Presentation

  • 15%–35% of initial presentation.
  • Common in supratentorial AVMs.
  • Related to hemorrhage, mass effect, or flow characteristics.
  • Risk factors: Superficial location, large nidus, cortical location.

Other Presentations

  • Neurological deficits (<10%): Possibly due to steal phenomenon, microhemorrhages, mass effect.
  • Headaches: May be due to meningeal artery involvement or venous outflow obstruction.

Old presentation

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