Controversies in the ARUBA trial and future treatment strategies for unruptured AVMs

Abstract

Unruptured cerebral arteriovenous malformations (AVMs) have diverse pathological conditions in individual cases. There are multiple treatment strategies, and treatment risks vary greatly from case to case. Therefore, it is difficult to determine an uniform treatment policy. Intermediate analysis of the ARUBA trial reported that conservative medical treatment is superior to invasive treatment for the purpose of preventing death and new stroke in patients with unruptured AVMs. Since its analysis includes minor changes on image examinations accompanied by minor symptoms in new symptomatic stroke, which is the main endpoint, its interpretation and application to clinical practice should be carefully performed. Due to the racial differences in AVM’s natural history, original research is needed in Japan, in which medical treatment group is set as standard treatment and the primary endpoint as long-term prognosis.