|Title||Effect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations.|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Reynolds AS, Chen ML, Merkler AE, Chatterjee A, Diaz I, Navi BB, Kamel H|
|Keywords||Databases, 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|
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.
|Alternate Journal||Cerebrovasc. Dis.|
|PubMed Central ID||PMC6759368|
|Grant List||K23 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