Effect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations

Abstract

Background: In 2013, investigators from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (AVM; ARUBA) reported that interventions to obliterate unruptured AVMs caused more morbidity and mortality than medical management. Objective: We sought to determine whether interventions for unruptured AVM decreased after publication of ARUBA results. Methods: We used the Nationwide Readmissions Database to assess trends in interventional AVM management in patients ≥18 years of age from 2010 through 2015. Unruptured brain AVMs were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 747.81 and excluding any patient with a diagnosis of intracranial hemorrhage. Our primary outcome was interventional AVM treatment, identified using ICD-9-CM procedure codes for surgical resection, endovascular therapy, and stereotactic radiosurgery. Join-point regression was used to assess trends in the incidence of interventional AVM management among adults from 2010 through 2015. Results: There was no significant U.S. population level change in unruptured brain AVM intervention rates before versus after ARUBA (p = 0.59), with the incidence of AVM intervention ranging from 8.0 to 9.2 per 10 million U.S. residents before the trial publication to 7.7–8.3 per 10 million afterwards. Conclusions: In a nationally representative sample, we found no change in rates of interventional unruptured AVM management after publication of the ARUBA trial results.

Radiotherapeutic management of brain tumours during the COVID-19 pandemic

“…The treatment decision-making algorithm proposed during the COVID-19 pandemic is given in Figure 1. The suggested treatment options for brain tumours [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] are enlisted in Table 1.…”

The impact of ARUBA on the clinical practice of unruptured brain arteriovenous malformations: big data, poor evidence and measuring impact on health policy

“…To date, two scientific analyses dissect the issue of the impact of the ARUBA trial on clinical practice, in particular in the USA [1,11]. Birnbaum and colleagues queried the Nationwide Inpatient Sample (NIS) database up to the end of 2015.…”

“…Reynolds and colleagues queried the National Readmissions Database, an HCUP database that is used to estimate readmission data, until the end of 2015 [11]. As per HCUP, National Readmission Database excludes rehabilitation and long-term acute care hospitals, unlike the NIS [11].…”

“…Reynolds and colleagues queried the National Readmissions Database, an HCUP database that is used to estimate readmission data, until the end of 2015 [11]. As per HCUP, National Readmission Database excludes rehabilitation and long-term acute care hospitals, unlike the NIS [11]. The authors found that there was no significant change in the rates of intervention for unruptured bAVMs in the period after ARUBA, compared to the period before ARUBA.…”

What neurointerventionists think about the treatment of unruptured brain arteriovenous malformations: the complexity of moving towards evidence-based treatment

“…One would assume that its results have led to a decrease in treatment rates. But unruptured brain AVMs continue to be treated, despite the rather discouraging outcomes of the ARUBA treatment arm [15]. Many operators use the alleged methodological flaws of the trial as a justification to treat (we are better/ select our patients better/use better devices/use different modalities than the operators in the trial).…”