Unruptured Arteriovenous Malformations
Victor Volovicia b, Joost Willem Schoutenb c, Peter Vajkoczyd, Rúben Dammersb e, Torstein Ragnar Melingf g h
- aCenter for Medical Decision Making, Department of Public Health (V.V.), Erasmus MC Rotterdam, the Netherlands
- bDepartment of Neurosurgery, Erasmus MC Stroke Center (V.V., J.W.S., R.D.), Erasmus MC Rotterdam, the Netherlands
- cJoost W. Schouten Department of Neurosurgery, Erasmus MC Stroke Center (V.V., J.W.S., R.D.), Erasmus MC Rotterdam, the Netherlands
- dDepartment of Neurosurgery, Charité University Hospital, Berlin, Germany (P.V.)
- eRuben Dammers https://orcid.org/0000-0001-7033-0644 Department of Neurosurgery, Erasmus MC Stroke Center (V.V., J.W.S., R.D.), Erasmus MC Rotterdam, the Netherlands
- fInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.R.M.)
- gNeurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Switzerland (T.R.M.)
- hTorstein R. Meling https://orcid.org/0000-0001-6595-0873 Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Switzerland (T.R.M.). Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (T.R.M.)
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Abstract
Brain arteriovenous malformations (bAVMs) are vascular lesions that carry significant morbidity and mortality risk upon rupture. bAVM rupture causes either intracerebral or intraventricular hemorrhage, or both. In 2014, the first results of the ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) were published in The Lancet , causing a paradigm shift in clinical practice and suggesting the superiority of medical treatment in terms of mortality or stroke compared with any intervention designed to obliterate the AVM. In 2020, the final results of the ARUBA trial were published. In this Viewpoint, we critically review the clinical equipoise behind the trial, highlight issues regarding external validity, and place the results of the trial in the context of other results in scientific literature of bAVMs using Bayesian inference. ARUBA is a trial of decision-making, and only proper knowledge of the nuances of its interpretation within the broader context of bAVM research can lead to proper decision-making when confronted with patients with unruptured bAVMs.
TL;DRThe clinical equipoise behind the ARUBA trial is critically reviewed, issues regarding external validity are highlighted, and the results of the trial are placed in the context of other results in scientific literature of bAVMs using Bayesian inference. (Semantic Scholar)