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      Effect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations

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          Abstract

          Background: In 2013, investigators from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (AVM; ARUBA) reported that interventions to obliterate unruptured AVMs caused more morbidity and mortality than medical management. Objective: We sought to determine whether interventions for unruptured AVM decreased after publication of ARUBA results. Methods: We used the Nationwide Readmissions Database to assess trends in interventional AVM management in patients ≥18 years of age from 2010 through 2015. Unruptured brain AVMs were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 747.81 and excluding any patient with a diagnosis of intracranial hemorrhage. Our primary outcome was interventional AVM treatment, identified using ICD-9-CM procedure codes for surgical resection, endovascular therapy, and stereotactic radiosurgery. Join-point regression was used to assess trends in the incidence of interventional AVM management among adults from 2010 through 2015. Results: There was no significant U.S. population level change in unruptured brain AVM intervention rates before versus after ARUBA ( p = 0.59), with the incidence of AVM intervention ranging from 8.0 to 9.2 per 10 million U.S. residents before the trial publication to 7.7–8.3 per 10 million afterwards. Conclusions: In a nationally representative sample, we found no change in rates of interventional unruptured AVM management after publication of the ARUBA trial results.

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          Author and article information

          Journal
          CED
          Cerebrovasc Dis
          10.1159/issn.1015-9770
          Cerebrovascular Diseases
          S. Karger AG
          1015-9770
          1421-9786
          2019
          September 2019
          21 August 2019
          : 47
          : 5-6
          : 299-302
          Affiliations
          [_a] aDepartment of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA
          [_b] bDepartment of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
          [_c] cDepartment of Neurology, Columbia College of Physicians and Surgeons, New York, New York, USA
          Author notes
          *Hooman Kamel, MD, Department of Neurology, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, 407 East 61st Street, 5th Floor, New York, NY 10065 (USA), E-Mail hok9010@med.cornell.edu
          Article
          502314 Cerebrovasc Dis 2019;47:299–302
          10.1159/000502314
          6759368
          31434094
          96273d97-c984-4e4d-969d-48a776f245e4
          © 2019 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          History
          : 05 June 2019
          : 17 July 2019
          Page count
          Tables: 2, Pages: 4
          Categories
          Original Paper

          Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
          Arteriovenous malformations,Neurosurgery,Neurology,Health services research

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