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 |
Journal | Cerebrovasc Dis |
Volume | 47 |
Issue | 5-6 |
Pagination | 299-302 |
Date Published | 2019 |
ISSN | 1421-9786 |
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 |
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. |
DOI | 10.1159/000502314 |
Alternate Journal | Cerebrovasc. Dis. |
PubMed ID | 31434094 |
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 |