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Comment & Response |

Conservative Management vs Intervention for Unruptured Brain Arteriovenous Malformations—Reply

Rustam Al-Shahi Salman, PhD1; Carl E. Counsell, MD2; Philip M. White, FRCR3
[+] Author Affiliations
1Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, Scotland
2Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
3Institute for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, England
JAMA. 2014;312(10):1058-1059. doi:10.1001/jama.2014.8759.
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In Reply Neurosurgical colleagues have raised issues about our study comparing conservative management and intervention for unruptured bAVMs that do not invalidate our findings but instead provide an opportunity to give more detail, correct misinterpretations, and reemphasize the hierarchy of evidence.1

First, it is unlikely that some of the “other” deaths in the conservative group were related to untreated bAVMs. Every death was adjudicated with all available clinical, radiographic, and pathological information. The 26 other deaths were due to cancer (n = 9), infection (n = 6), cardiovascular disease (n = 5), ischemic stroke unrelated to bAVM (n = 4), subdural hematoma unrelated to bAVM (n = 1), and drug overdose (n = 1). Dr Zaidi and colleagues note that 4 deaths in the intervention group and 11 deaths in the conservative group were possibly due to bAVM. Given that we did not prespecify this comparison, a post hoc comparison should be interpreted cautiously; we will continue to monitor deaths.

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September 10, 2014
Gregory M. Weiner, MD; Ramesh Grandhi, MD; Robert M. Friedlander, MD
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA. 2014;312(10):1057-1058. doi:10.1001/jama.2014.8748.
September 10, 2014
Hasan A. Zaidi, MD; Jonathan J. Russin, MD; Robert F. Spetzler, MD
1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
JAMA. 2014;312(10):1058. doi:10.1001/jama.2014.8751.
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