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

TitleEffect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations.
Publication TypeJournal Article
Year of Publication2019
AuthorsReynolds AS, Chen ML, Merkler AE, Chatterjee A, Diaz I, Navi BB, Kamel H
JournalCerebrovasc Dis
Volume47
Issue5-6
Pagination299-302
Date Published2019
ISSN1421-9786
KeywordsDatabases, Factual, Endovascular Procedures, Health Services Research, Humans, Intracranial Arteriovenous Malformations, Neurosurgical Procedures, Practice Patterns, Physicians', Randomized Controlled Trials as Topic, Risk Assessment, Time Factors, Treatment Outcome, United States
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.

DOI10.1159/000502314
Alternate JournalCerebrovasc. Dis.
PubMed ID31434094
PubMed Central IDPMC6759368
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
P50 MH113838 / MH / NIMH NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
R01 AG057931 / AG / NIA NIH HHS / United States
R03 AG056446 / AG / NIA NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States

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