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New Study Supports Conservative Management Over Intervention for Unruptured Brain AVMsFitzgerald, Susan
During up to 12 years of follow-up, the risk of a nonfatal stroke or death due to brain arteriovenous malformation, arterial aneurysm, or intervention was lower for patients treated medically compared with those who underwent neurosurgical excision, endovascular embolism, stereotactic radiotherapy, or a combination of these therapies.
Patients with an unruptured brain arteriovenous malformation (AVM) who received conservative medical management fared better in the long term than patients who underwent an intervention, according to a population-based study from Scotland.
During up to 12 years of follow-up, the risk of a nonfatal stroke or death due to brain AVM, arterial aneurysm, or intervention was lower for patients treated medically compared with those who underwent neurosurgical excision, endovascular embolism, stereotactic radiotherapy, or a combination of these therapies.
The Scottish study, published in the April 23/30 edition of Journal of the American Medical Association (JAMA), included 204 patients, 103 of whom underwent an intervention and 101 who did not. The patients, who were at least 16 years old, were diagnosed with an unruptured brain AVM during 1999–2003 or 2006–2010.
Using anonymous data from the Scottish National Health Service, researchers followed the patients prospectively. The patients who underwent an intervention tended to be younger, more likely to have presented with seizures, and less likely to have a large brain AVM (exceeding 6 cm) than those who did not get an intervention.
The study's primary outcome was death or sustained morbidity due to any cause by measure of the Oxford Handicap Scale.
“During a median follow-up of 6.9 years, the rate of progression to the primary outcome was lower with conservative management during the first 4 years of follow-up (36 versus 39 events; a relative risk reduction of 41 percent) but rates were similar thereafter,” the researchers reported.
When it came to the secondary outcome measure — nonfatal symptomatic stroke or death due to brain AVM, associated arterial aneurysm or intervention — “the rate of the secondary outcome was lower with conservative management during 12 years of follow-up (14 versus 38 events; a relative risk reduction of 63 percent),” according to the researchers. Seven symptomatic strokes occurred within 30 days of intervention.
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