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Unruptured AVM – ARUBA Trial — SCE Neurology MCQ

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HardCerebrovascular DiseaseUnruptured AVM – ARUBA TrialSCE Neurology

A 65-year-old man with a known unruptured brain AVM is being discussed at the neurovascular MDT. He has had one seizure which is now controlled on levetiracetam. The AVM is a Spetzler-Martin grade 3 in the left motor cortex. After the ARUBA trial, what is the general consensus regarding management of unruptured brain AVMs?

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Correct answer: E — The ARUBA trial showed that conservative management is superior to interventional therapy for unruptured AVMs in terms of stroke and death outcomes

The ARUBA trial (A Randomized trial of Unruptured Brain AVMs, 2014) demonstrated that medical management alone was superior to interventional therapy (surgery, embolisation, or radiosurgery) for the prevention of death or symptomatic stroke in patients with unruptured brain AVMs over a mean follow-up of 33 months. This has shifted practice towards conservative management for many unruptured AVMs, though the trial had limitations and individual cases are discussed at MDT. A: Not all AVMs require resection. C: Embolisation alone is not always appropriate. D: Radiosurgery is size-limited. E: Anticoagulation is not indicated.

Reference: ARUBA Trial (2014); RCP National Clinical Guideline for Stroke (2023)