Management of Brain Arteriovenous Malformations : Current Status and Future Perspectives

Abstract

  The ARUBA trial, which was a randomized trial, showed that in patients with unruptured brain arteriovenous malformations (bAVMs) followed for 33 months, medical treatment alone was superior to interventional therapy for the prevention of death or stroke. Since the publication of its results, this trial has experienced heavy criticisms in relation to its inappropriate design, low enrollment rate, low rate of surgical treatment, extremely short follow-up periods, and inappropriate conclusions. A number of researchers claimed that these issues are against the concept of prophylactic therapy, “to take an upfront risk to gain a long term benefit.” These critiques beg therefore for other trials to reestablish the management strategy for unruptured bAVMs. Three new projects (Prospective European Multimodality Registry, BARBADOS, and TOBAS) are currently being planned and partially launched.