Analysis From NVQI-QOD Finds Surgery Safe and Effective for Treating Unruptured AVMs

August 8, 2023—Using the Neurovascular Quality Initiative Quality Outcomes Database (NVQI-QOD), an analysis of surgical approaches (embolization, microsurgery, and radiosurgery) for treating selected patients with unruptured arteriovenous malformation (AVM) found these treatments are safe and effective.

A press release from the Society of NeuroInterventional Surgery (SNIS) noted that the study’s conclusion counters that of the seminal long-term ARUBA study published in 2014, which found that surgery should be avoided and that management of unruptured AVMs should focus on treating symptoms, including headaches and seizures.

The new study, “Treatment Outcomes for ARUBA-Eligible Brain Arteriovenous Malformations: A Comparison of Real-World Data from the NVQI-QOD AVM Registry to the ARUBA Trial,” was presented at SNIS 2023, the society’s 20th annual meeting held July 31 to August 4 in San Diego, California.

The 33-month follow-up data from ARUBA was published by Professor Jay P. Mohr, MD, et al in The Lancet (2014;383:614-621). Randomization in the study was halted early on the recommendation of a data and safety monitoring board because of superiority of the medical management group. Final 5-year observational follow-up from ARUBA was published in July 2020 by Prof. Mohr et al in The Lancet Neurology (2020; 19:573-581).

According to the SNIS press release, the NVQI-QOD study’s investigators reported that the limitations of the ARUBA study’s results make it less generalizable to determine the guideline for treating individuals with unruptured AVMs, and that neurointerventionalists and neurosurgeons can surgically treat unruptured AVMs successfully for carefully selected patients.

As summarized in the SNIS press release, the investigators reviewed patient information from hospitals and surgical centers around the United States using the NVQI-QOD. The investigators specifically analyzed records for 173 patients who are ARUBA-eligible with similar demographics and characteristics of the AVMs.

They found that the rate of death or stroke was 8.7% in the surgically treated patients from the database study versus 30.7% in the ARUBA trial. There was no difference in the risk of stroke and/or death among the surgical modalities used. Additionally, the rate of physical impairment postsurgery was 25.4% in the database study versus 46.2% in the ARUBA trial.

The NVQI-QOD study investigators suggest that comprehensive stroke centers across the United States would be able to safely surgically treat unruptured AVMs, stated the SNIS press release.

The collaborative study was led by a team from the Cleveland Clinic in Cleveland, Ohio. Nina Moore, MD, who is a researcher and neurosurgeon at the Cleveland Clinic, is senior author of the study. Anas Alrohimi, MD, the study’s primary author, is a neuroendovascular surgery fellow at the Cleveland Clinic.

“We performed a retrospective analysis of prospectively collected data of ARUBA-eligible patients, who underwent intervention at 18 participating centers,” commented Dr. Moore in the SNIS press release. “Our results suggest that intervention for unruptured brain AVMs at comprehensive stroke centers across the United States is safe and effective.”

Dr. Alrohimi added, “Seeing through this data that neurointerventionalists and neurosurgeons can safely treat unruptured brain AVMs via different surgical modalities is very encouraging. In this constantly evolving field, it is crucial we continue to investigate new procedures that impact the patients’ outcomes. It’s exciting to open up opportunities to manage this potentially deadly condition and improve patients’ quality of life.”