Results of ARUBA Are Applicable to Most Patients With Nonruptured Arteriovenous Malformations

2006 (Kissimmee, FL) was the last such controversy session on brain arteriovenous malformations (AVMs) at an International Stroke Conference. The patient then was somewhat older but raised similar management issues. Intervention had produced a major stroke. A dissatisfied interventionalist in the audience was overheard to murmur, “I want some answers.” A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) trial had just been funded by National Institutes of Neurological Diseases and Stroke (NINDS) but had not begun.Some additional information would help hemorrhage risk assessment for the current case. Evidence of previous hemorrhage, symptomatic or not, raises the risk of further hemorrhage; based on current practice, it would argue for intervention with a goal of lesion eradication. Recent onset headaches could mean she is developing venous stenosis or dilatation, thought by some a risk factor for hemorrhage, albeit not easily treated. If the AVM site straddles the arterial borderzones, risk of first hemorrhage would be lower than for sites elsewhere. To be …