TY - JOUR
T1 - Unruptured Arteriovenous Malformations
T2 - Do We Have an Answer after the Final Follow-Up of ARUBA? A Bayesian Viewpoint
AU - Volovici, Victor
AU - Schouten, Joost W.
AU - Vajkoczy, Peter
AU - Dammers, Ruben
AU - Meling, Torstein R.
N1 - Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85102221666&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.032429
DO - 10.1161/STROKEAHA.120.032429
M3 - Review article
C2 - 33494639
AN - SCOPUS:85102221666
SN - 0039-2499
VL - 52
SP - 1143
EP - 1146
JO - Stroke
JF - Stroke
IS - 3
ER -