This article is more than 5 years old. Information may no longer be current.
Conservative management of vascular abnormality in brain associated with improved outcomes
Patients with unruptured brain arteriovenous malformations experienced better long-term outcomes with conservative management compared with intervention, according to results from a population-based, inception, cohort study.
Researchers evaluated 204 patients from Scotland aged 16 years or older who were diagnosed with unruptured brain arteriovenous malformations between 1999 and 2003 or 2006 and 2010. Patients underwent either conservative management without intervention (n=101) or underwent intervention with endovascular embolization, neurosurgical excision or stereotactic radiosurgery (n=103).
The primary outcome was death or sustained morbidity. Nonfatal symptomatic stroke or death as a result of the malformations, related arterial aneurysm or the intervention served as the secondary outcome.
Patients underwent 12 years of prospective follow-up (median, 6.9 years; 1,479 person-years). Follow-up was significantly longer in the intervention group, due to most deaths occurring in the conservative management group (median, 9.4 years vs. 5.2 years; P=.002).
Patients who received conservative management had a lower rate of progression to death or sustained morbidity within 4 years (9.5 events per 100 person-years vs. 9.8 events per 100 person-years; adjusted HR=0.59; 95% CI, 0.35-0.99). The between-group difference did not persist after 4 years. Death occurred significantly more frequently in the conservative management group during 12 years (3.7 deaths per 100 person-years vs. 1.1 deaths per 100 person-years; HR=3.64; 95% CI, 1.78-7.43); however, this difference was not attributable to arteriovenous malformations (P=.29), but death rather due to other causes (P<.001) and was no longer significant after adjustment for age.
Incidence of the secondary outcome was lower in the conservative management group during follow-up (1.6 events per 100 person-years vs. 3.3 events per 100 person-years; adjusted HR=0.37; 95% CI, 0.19-0.72), which researchers attributed to an increased number of symptomatic strokes as a result of the intervention.
“Longer follow-up is required to understand whether this association is persistent,” the researchers wrote.
Disclosure: One researcher reported receiving grants and personal fees from Codman, Covidien and Microvention Terumo during the study.