20 Feb Unruptured Brain Arteriovenous Malformations: Treat or Leave Alone?

MedicalResearch.com Interview with:

Dr. Christian Stapf

Christian Stapf, MD
Full Professor, Department of Neurosciences
Université de Montréal
Principal Scientist, CRCHUM
Montréal Canada 

Medical Research: What is the background for this study?

Dr. Stapf: Brain arteriovenous malformations are abnomal tangles of falsely linked arteries and veins in the brain. They may be asymptomatic, or lead to headaches, epileptic seizures or – worst case – to stroke, usually by intracranial hemorrhage. Brain AVMs are relatively rare, but approximately 5000 patients are discovered every year in the U.S.and Canada, 3000 of whom will have an unruptured malformation at the diagnosis.

The ARUBA trial tested if it was better to remove an unruptured  Brain arteriovenous malformations in order to prevent death and stroke, or if patients were better off living with an AVM without undergoing intervention.

Medical Research: What are the main findings?

Dr. Stapf:  The trial results showed that an initially unruptured Brain arteriovenous malformations if left untreated may lead to hemorrhage in 2.1% every year. However this risk increases by the factor 4.5, if you start treating the AVM for attempted eradication. The risk of developing a significant neurological deficit also increase by the factor 2.5 after treatment, and there was no benefit for epileptic seizures or headaches.

Medical Research: What should clinicians and patients take away from your report?

Dr. Stapf: Living with an unruptured brain  Brain arteriovenous malformations is far safer than to attempt interventional therapy. This is true when looking at all interventional treatment types (surgery, embolization or radiotherapy). Leaving an unruptured AVM untreated reduces the risk of death and stroke by 78%.

Medical Research: What should clinicians and patients take away from your report?

Dr. Stapf: Preventive intercventions in patients diagnosed with an unruptured brain AVM are potentially dangerous, and cannot safely be recommended based on current knowledge. We have to find safer ways to treat these lesions without adding more harm.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Stapf: The trial was funded by NIH/NINDS and patients were enrolled at specialized Treatment Centers across the U.S., Canada, Brazil, South Corea, and eight European countries.

Citation: Presented at 2016 ISC Conference February 2016

Carotid Endarterectomy versus Stenting for Treatment of Carotid Artery Stenosis: Long-term Results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)

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Last Updated on February 20, 2016 by Marie Benz MD FAAD