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Medical Management Alone Better for Brain AV Malformations

Risk of stroke or death up with medical management plus interventional therapy for unruptured AVM

THURSDAY, July 2, 2020 (HealthDay News) — Among patients with unruptured brain arteriovenous malformation, medical management alone is superior to its combination with interventional therapy for prevention of death or symptomatic stroke in the long term, according to a study published in the July 1 issue of The Lancet Neurology.

Jay P. Mohr, M.D., from the Columbia University Irving Medical Center in New York City, and colleagues conducted a nonblinded randomized trial at 39 clinical centers in nine countries to compare medical management alone to the combination of medical management and interventional therapy for patients with an unruptured brain arteriovenous malformation. Patients were enrolled from April 4, 2007, to April 15, 2013, and were followed-up through July 15, 2015.

A total of 110 and 116 patients were randomly assigned to medical management alone or medical management plus interventional therapy, respectively. The researchers found that the incidence of death or symptomatic stroke was lower with medical management alone versus medical management with interventional therapy during a mean follow-up of 50.4 months (3.39 versus 12.32 per 100 patient-years; hazard ratio, 0.31). Adverse events occurred less often in the medical management versus medical management plus interventional therapy group (58.97 versus 78.73 per 100 patient-years; risk difference, −19.76).

“In the long term, standard medical care is more beneficial for the patient than any intervention,” a coauthor said in a statement. “This certainly shakes up conventional thinking about how to prevent stroke in these patients.”

One author disclosed financial ties to the pharmaceutical industry.

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