Department of Neurosurgery, Erasmus MC Stroke Center (V.V., J.W.S., R.D.), Erasmus MC Rotterdam, the Netherlands.
Center for Medical Decision Making, Department of Public Health (V.V.), Erasmus MC Rotterdam, the Netherlands.
Stroke. 2021 Mar;52(3):1143-1146. doi: 10.1161/STROKEAHA.120.032429. Epub 2021 Jan 26.
Brain arteriovenous malformations (bAVMs) are vascular lesions that carry significant morbidity and mortality risk upon rupture. bAVM rupture causes either intracerebral or intraventricular hemorrhage, or both. In 2014, the first results of the ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) were published in , causing a paradigm shift in clinical practice and suggesting the superiority of medical treatment in terms of mortality or stroke compared with any intervention designed to obliterate the AVM. In 2020, the final results of the ARUBA trial were published. In this Viewpoint, we critically review the clinical equipoise behind the trial, highlight issues regarding external validity, and place the results of the trial in the context of other results in scientific literature of bAVMs using Bayesian inference. ARUBA is a trial of decision-making, and only proper knowledge of the nuances of its interpretation within the broader context of bAVM research can lead to proper decision-making when confronted with patients with unruptured bAVMs.
脑动静脉畸形（bAVMs）是一种血管病变，破裂后会带来显著的发病率和死亡率风险。bAVM 破裂会导致脑内或脑室出血，或两者皆有。2014 年，ARUBA 试验（未破裂脑动静脉畸形的随机试验）的首批结果发表于 ，这一结果引发了临床实践的范式转变，并表明在死亡率或卒中方面，与旨在消除 AVM 的任何干预措施相比，药物治疗具有优越性。2020 年，ARUBA 试验的最终结果发表。在这篇观点文章中，我们批判性地回顾了试验背后的临床均衡性，强调了外部有效性的问题，并使用贝叶斯推断，将试验结果置于 bAVM 科学文献中的其他结果的背景下。ARUBA 是一项决策试验，只有在 bAVM 研究的更广泛背景下正确了解其解释的细微差别，才能在面对未破裂的 bAVM 患者时做出正确的决策。
