Abstract TP585: Long-Term Outcomes in Unruptured Brain Arteriovenous Malformation Patients: The Multicenter Arteriovenous Malformation Research Study (MARS)

Kim, Helen; Salman, Rustam Al‐Shahi; Flemming, Kelly D.; Flint, Alexander C.; Hess, Christopher P.; Hetts, Steven W.; Krings, Timo; Laakso, Aki; Lanzino, Giuseppe; Lawton, Michael T.; McCulloch, Charles E.; Mohr, J. P.; Morgan, Michael K.; Moy, Claudia S.; Nakaji, Peter; Pereira, V Mendes; Ribeiro, Diego Sgarabotto; Stapf, Christian; Stefani, Marco Antônio; Zaroff, Jonathan G.; Zhao, Yuanli

doi:10.1161/str.50.suppl_1.tp585

Cited by 3 publications

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“…The MARS (Multicenter Arteriovenous Malformation Research Study) is a collaborative multicenter study with a target enrollment of 4500 unruptured bAVMs. 56 Initial findings from MARS indicate that a hemorrhagic presentation is a significant predictor of subsequent hemorrhage and that the likelihood increases with the patient’s age. 7 Another significant registry is the SIVMS (Scottish Intracranial Vascular Malformation Study), a prospective population-based registry including patients diagnosed with any type of vascular malformation in Scotland.…”

Section: Clinical Trials and Registriesmentioning

confidence: 99%

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

Samaniego,

Dabus,

Meyers

et al. 2024

Stroke

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Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.

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Section: Clinical Trials and Registriesmentioning

confidence: 99%

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

Samaniego,

Dabus,

Meyers

et al. 2024

Stroke

Self Cite

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Medical management with interventional therapy versus medical management alone for unruptured brain arteriovenous malformations (ARUBA): final follow-up of a multicentre, non-blinded, randomised controlled trial

Mohr

Overbey

Hartmann

et al. 2020

The Lancet Neurology

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127

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Interventional outcomes for patients eligible for entry into the ARUBA clinical trial: a systematic review and meta-analysis

Snyder¹,

Chen²,

Farzad³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that medical management afforded outcomes superior to those following intervention for unruptured arteriovenous malformations (AVMs), but its findings have been controversial. Subsequent studies of AVMs that would have met the eligibility requirements of ARUBA have supported intervention for the management of some cases. The present meta-analysis was conducted with the object of summarizing interventional outcomes for ARUBA-eligible patients reported in the literature. METHODS A systematic literature search (PubMed, Web of Science, Google Scholar) for AVM intervention studies that used inclusion criteria identical to those of ARUBA (age ≥ 18 years, no history of AVM hemorrhage, no prior intervention) was performed. The primary outcome was death or symptomatic stroke. Secondary outcomes included AVM obliteration, hemorrhage, death, and poor outcome (modified Rankin Scale score ≥ 2 at final follow-up). Bias assessment was performed with the Newcastle-Ottawa Scale, and the results were synthesized as pooled proportions. RESULTS Of the 343 articles identified through database searches, 13 studies met the inclusion criteria, yielding an overall study cohort of 1909 patients. The primary outcome occurred in 11.2% of patients (pooled = 11%, 95% CI 8%–13%). The rates of AVM obliteration, hemorrhage, poor outcome, and death were 72.7% (pooled = 78%, 95% CI 70%–85%), 8.4% (pooled = 8%, 95% CI 6%–11%), 9.9% (pooled = 10%, 95% CI 7%–13%), and 3.5% (pooled = 2%, 95% CI 1%–4%), respectively. Annualized primary outcome and hemorrhage risks were 1.85 (pooled = 2.05, 95% CI 1.31–2.94) and 1.34 (pooled = 1.41, 95% CI 0.83–2.13) per 100 patient-years, respectively. CONCLUSIONS Intervention for unruptured AVMs affords acceptable outcomes for appropriately selected patients. The risk of hemorrhage following intervention compared favorably to the natural history of unruptured AVMs. The included studies were retrospective and varied in treatment and AVM characteristics, thereby limiting the generalizability of their data. Future studies from prospective registries may clarify patient, nidus, and intervention selection criteria that will refine the challenging management of patients with unruptured AVMs.

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Abstract TP585: Long-Term Outcomes in Unruptured Brain Arteriovenous Malformation Patients: The Multicenter Arteriovenous Malformation Research Study (MARS)

Cited by 3 publications

References 0 publications

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations

Medical management with interventional therapy versus medical management alone for unruptured brain arteriovenous malformations (ARUBA): final follow-up of a multicentre, non-blinded, randomised controlled trial

Interventional outcomes for patients eligible for entry into the ARUBA clinical trial: a systematic review and meta-analysis

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