Increased Incidence of Ruptured Cerebral Arteriovenous Malformations and Mortality in the United States: Unintended Consequences of the Aruba Trial?
Author Type(s)
Faculty
Document Type
Abstract
Publication Date
2022
DOI
10.1136/neurintsurg-2022-SNIS.44
Journal Title
Journal of NeuroInterventional Surgery
Department
Neurology
Second Department
Neurosurgery
Abstract
Introduction/Purpose The findings of the A Randomized Trial of Unruptured Brain Arteriovenous Malformation (ARUBA) trial, which determined that medical management was superior to prophylactic interventional therapy for the treatment of unruptured cerebral arteriovenous malformations (cAVMs), remain polarizing and controversial. Previous analyses of national registry data have demonstrated decreased rates of endovascular and surgical intervention for unruptured cAVMs following the publication of the ARUBA trial in 2014. Materials and Methods Adult cAVM patient admissions were identified in the National Inpatient Sample (NIS) from 2009 to 2019 using International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes. The incidence of cAVM rupture and in-hospital mortality were compared between the pre- (2009-2013) and post-ARUBA trial eras (2014-2019) using complex samples weighted estimates. Results Among 121,415 hospitalizations for cAVM during the study period, 31,389 (25.9%) were admissions for acutely ruptured malformations. The incidence of both ruptured cAVM (13.3% vs. 34.4%, p<0.001) as well as rates of in-hospital mortality (2.0% vs. 7.6%, p<0.001) significantly increased in the post-ARUBA trial era. Following multivariable regression analysis adjusting for age, illness severity, and acute neurological condition, the post-ARUBA trial era was independently associated with both cAVM rupture (aOR 1.99, 95% CI 1.72 to 2.29; p<0.001) and in-hospital mortality (aOR 1.94, 95% CI 1.37 to 2.75; p<0.001). Conclusion The incidence of ruptured cAVM increased following 2014, potentially a reflection of a paradigm shift to conservative and non-interventional management strategies in unruptured cAVM patients. Further studies may be necessary to exclude other confounders contributing to this rise.
Recommended Citation
Dicpinigaitis, A., Ogulnick, J., Cooper, J., mayer, S., Gandhi, C., & Al-Mufti, F. (2022). Increased Incidence of Ruptured Cerebral Arteriovenous Malformations and Mortality in the United States: Unintended Consequences of the Aruba Trial?. Journal of NeuroInterventional Surgery, 14, A29. https://doi.org/10.1136/neurintsurg-2022-SNIS.44
