Open Questions in Acute Stroke Management and Stroke Prevention

Abstract

In this journal, several authors discuss current issues of acute stroke management and stroke prevention compared with recently published trials of still uncertain clinical significance, for example, what impact on clinical practice has occurred from the large exciting ARUBA study. Reynolds et al. [1] from New York, USA, present their analysis for intervention for brain arteriovenous malformation before and after the publication of ARUBA in the United States (Unruptured Brain Arteriovenous Malformations – AVM; ARUBA). Based on a Nationwide Readmissions Database to assess trends in interventional AVM management in patients ≥18 years of age from 2010 through 2015, they did not observe a significant U.S. population-level change in unruptured brain AVM intervention rates before versus after ARUBA (p = 0.59). The incidence of AVM intervention ranged from 8.0 to 9.2 per 10 million U.S. residents before the trial publication to 7.7–8.3 per 10 million afterwards. The authors discussed carefully the pros and cons of their observation and needs for further investigations.