Management of unruptured arteriovenous malformations (AVMs) has changed since the publishing of the ARUBA trial findings, according to data presented at the International Stroke Conference 2022.

“The real-world evolution of management and outcomes of patients with unruptured cerebral [AVMs] has not been well-delineated following the ARUBA trial findings of no general advantage of initial interventional (surgical/endovascular/radiotherapy) vs initial conservative medical therapy,” wrote Smit D. Patel, MD, MPH, University of California Los Angeles Medical Center.

Dr Patel et al assessed a total of 72,812 patients with unruptured AVMs from the National Inpatient Sample of AVM admissions in the United States from 2009 to 2018 in 2 groups, 37,392 cases from before the ARUBA trial (2009-2013) and 35,420 cases from after the ARUBA trial (2014-2018).

Among patients in the post-ARUBA group, intervention rates were lower when compared with those of patients in the pre-ARUBA period, with the interventional rate decreasing monotonically by -4.32%.

Rates of in-hospital ischemic stroke and in-hospital mortality were similar in both groups, but the likelihood of combined discharge to a facility or in-hospital mortality increased. Admissions for ruptured AVMs also increased for patients in the post-ARUBA group.

According to the researchers, the nationwide practices for the management of unruptured AVMs changed significantly following the ARUBA trial.

“Fewer admissions with interventional treatment of unruptured arteriovenous malformations occurred and a corresponding increase in admission for ruptured arteriovenous malformations transpired, as expected with a strategy of watchful waiting and treatment only after an index bleeding event,” concluded Dr Patel et al.

Patel, Smit D. Long-term Impact Of Aruba Trial On Management And Outcomes Of Unruptured Intracranial Arteriovenous Malformations. Presented at: International Stroke Conference 2022; February 9-1; virtual.