Abstract WMP115: Interventional Therapy for Brain AVMs Before and After ARUBA
Introduction: The ARUBA Trial (2014) concluded that medical management alone is superior to medical management plus interventional therapy in the management of unruptured brain arteriovenous malformations (bAVMs). This sparked considerable controversy among involved healthcare providers.
Hypothesis: We hypothesize that the publication of ARUBA impacted the volume and type of bAVMs treated in a large tertiary care center.
Methods: This was a retrospective review of a prospectively maintained database of bAVMs treated at Stanford Hospital and Clinics from January 2012 through July 2015. The study period was divided into three phases: the ‘pre-ARUBA phase’, consisting of the 17 months prior to the presentation of ARUBA Trial Results at the XXII European Stroke Conference (ESC) (Jan 1, 2012 - May 31, 2013), the ‘transition phase’, consisting of the 8 months between ESC XXII and the ARUBA publication in Lancet (June 1, 2013 - Feb 15, 2014), and the ‘post-ARUBA phase’, or the 17 months following the Lancet publication (Feb 16, 2014 - July 31, 2015).
Results: Thirty patients were treated in the ‘pre-ARUBA phase’ (1.8/month), 23 in the ‘transition phase’ (2.7/month) and 37 in the ‘post-ARUBA phase’ (2.2/month). The percentage of treated bAVMs that were not ruptured at the time of presentation was 40%, 57%, and 46% in these study phases, respectively (chi-square statistic=5.96, p=0.05), and the mean S-M for each phase was 2.6, 3.0 and 2.4, respectively. The percentage of patients undergoing surgery as a component of their treatment regimen was 60% in both the pre- and post-ARUBA phases, whereas the percentage undergoing CyberKnife radiosurgery was 23% and 22%, respectively. There is no difference in the percentage of patients treated with each modality in the pre- and post-ARUBA phases (chi-square statistic=0.41, p=0.94).
Conclusions: The volume and type (ruptured vs. unruptured, S-M Grade) of bAVMs treated at one large neurosurgery referral center has been relatively unchanged in the period of time leading up to and following ARUBA. Furthermore, there has been no change in the frequency of the various treatment modalities throughout the period in study. Additional research is necessary to more thoroughly characterize the impact of ARUBA on the treatment patterns of bAVMS.
Author Disclosures: E. Sussman: None. M. Teo: None. A. Iyer: None. A. Ho: None. A. Pendharkar: None. R. Dodd: None. G. Steinberg: None.
- © 2016 by American Heart Association, Inc.