Deans' stroke musings: Unruptured cerebral arteriovenous malformations are better off treated medically: the ARUBA trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, September 13, 2017

Unruptured cerebral arteriovenous malformations are better off treated medically: the ARUBA trial

An earlier analysis of this ARUBA trial suggests treatment rather than non-treatment. Read about it here:

Leading Cause of Stroke in Young Going Untreated – and It Shouldn’t, Study Finds - AVMs

Lots of questions for your doctor to answer.

Unruptured cerebral arteriovenous malformations are better off treated medically: the ARUBA trial

A cerebral arteriovenous malformation (AVM) is an abnormal set of direct connections between the arteries and veins in the brain. These can cause a variety of neurologic symptoms, especially if they are large, and especially if they rupture.

arteriovenous malformation in the great cerebral vein of Galen; from Wikipedia user Filip em via Dr Laughlin Dawes

Mohr et al. recently published the result of the ARUBA trial, which compared medical (i.e., medical treatment for symptoms as needed) to interventional (i.e., surgical) treatment of this condition.
Their intention-to-treat analysis favored event-free survival in the medical management (MM; red) group:

Mohr et al 2017; doi: 10.1212/WNL.0000000000004532

The actually-treated analysis favored event-free survival in the medical management (MM) group even more strongly:

Mohr et al 2017; doi: 10.1212/WNL.0000000000004532

The authors suggest on the basis of this data that a reasonable management approach for unruptured cerebral AVM is to wait to see if a hemorrhage occurs, which may be mild if it does occur, and only then consider surgical intervention.