The ARUBA trial provides Level 1 evidence comparing interventional outcomes versus medical management for AVM stroke prevention.
Treatment Evidence Probe
Input the specific AVM presentation to review the ARUBA trial's consensus on interventional versus conservative management strategies.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Counseling patients with unruptured brain arteriovenous malformations (bAVMs).
Selecting candidates for medical management vs. intervention (surgery, embolization, or radiosurgery).
Reviewing the standard of care based on large-scale clinical trial data.
Section 2
Literature
Development
The ARUBA trial (2014) was a multicenter, international randomized trial that compared medical management alone vs. medical management plus interventional therapy for unruptured AVMs. It was halted early after 33 months because of a significantly lower risk of death or stroke in the medical management group (10.1% vs 30.7%).
Section 3
Pearls/Pitfalls
The Conservative Shift
ARUBA fundamentally changed neurosurgical practice by proving that the *treatment* of unruptured AVMs often carries more immediate risk than the *natural history* of the disease itself. For many neurosurgeons, ARUBA-eligibility implies a "hands-off" approach unless high-risk factors (e.g. from the Lawton-Young scale) are present.
Section 4
Evidence Appraisal
Primary Reference
Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA)
