[Correspondence] Management of brain arteriovenous malformations

The investigators of ARUBA (Feb 15, p 614) must be thoroughly applauded for conducting the first-ever randomised controlled trial of a therapeutic intervention to improve the prognosis of brain arteriovenous malformations. In view of the antagonism to the trial in some quarters, they were lucky to get even the 223 patient sample size they did, even though it was much smaller than the originally intended 800, subsequently modified to 400. However, they were not so lucky with their Data and Safety Monitoring Board who recommended halting randomisation at a mean of less than 3 years, before—possibly long before—enough follow-up had accrued to answer the crucial question: are the inevitable and already well known early risks of intervention, as well as any later ones that might emerge, worth taking in the long run for a condition that might or might not cause stroke or death several decades after presentation? This is a general problem with trials of surgery and other interventions with high up-front risk, for example of carotid endarterectomy to prevent stroke.
Source: LANCET - Category: Journals (General) Authors: Tags: Correspondence Source Type: research