IMPACT OF ARUBA TRIAL ON CURRENT PRACTICE: INTERVENTIONAL TREATMENT AND STROKE RATES IN UNRUPTURED BRAIN ARTERIOVENOUS MALFORMATIONS

Abstract

Brain AVMs are the abnormal connection between veins and arteries of the brain, that can lead to headaches, seizures, and hemorrhages. The choice of treatment for bAVMs depends on several factors, such as the size and location of the malformations, the severity of symptoms, and the risk of hemorrhage. The ARUBA was a clinical trial that aimed to determine the best treatment approach for unruptured AVMs. Its results showed that conservative management was associated with a significantly lower risk of death or stroke compared to intervention, leading to a shift in the practice of neurosurgeons. In this review, trends in the post-ARUBA rates of stroke and interventions for unruptured bAVMs are discussed. A noticeable decrease in the number of interventions for unruptured bAVMs has been seen post-ARUBA. This reduction has been particularly evident in minimally invasive procedures such as endovascular embolization and stereotactic radiosurgery. However, microsurgery, which is considered the gold standard for small-sized bAVMs, has remained consistent in terms of the number of procedures performed for ARUBA-eligible patients.