The following is a sampling of editorials and papers published in response to the ARUBA trial (listed as number 1 below). I can summarize the critics by noting that the nicest thing anyone said about the trial was that that the authors are to be “commended” for at least trying….followed by elaboration of multiple, and presumably fatal, study design flaws. The point, counter-point by Drs. Mohr and Amin-Hanjani is particularly interesting since it puts it into perspective from a specific patient standpoint.

1. Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet 2014;383(9917):614–21, 10.1016/S0140-6736(13)62302-8

2. Bambakidis N. Preliminary results of the ARUBA study. Neurosurgery 2013;73(2):E379–81

3. Cockroft KM, Jayaraman M V, Amin-Hanjani S, et al. A perfect storm: how a randomized trial of unruptured brain arteriovenous malformations’ (ARUBA’s) trial design challenges notions of external validity. Stroke 2012;43(7):1979–81, 10.1161/STROKEAHA.112.652032.

4. Pierot L, Fiehler J, Cognard C, et al. Will a randomized trial of unruptured brain arteriovenous malformations change our clinical practice? AJNR Am J Neuroradiol 2014;35(3):416–17, 10.3174/ajnr.A3867

5. Knopman J. Management of unruptured brain arteriovenous malformations. Lancet 2014;383:581–83, 10.1016/S0140-6736(14)60001-5

6. Day AL, Dannenbaum M, Jung S. A randomized trial of unruptured brain arteriovenous malformations trial: an editorial review. Stroke 2014;45(10):3147–48, 10.1161/STROKEAHA.114.004614

7. Mohr JP. Results of ARUBA are applicable to most patients with nonruptured arteriovenous malformations. Stroke 2014;45(5):1541–42, 10.1161/STROKEAHA.113.002698

8. Amin-Hanjani S. ARUBA results are not applicable to all patients with arteriovenous malformation. Stroke 2014;45(5):1539–40, 10.1161/STROKEAHA.113.002696

9. Rutledge WC, Abla AA, Nelson J, Halbach V V, Kim H, Lawton MT. Treatment and outcomes of ARUBA-eligible patients with unruptured brain arteriovenous malformations at a single institution. Neurosurg Focus 2014;37(3):E8, 10.3171/2014.7.FOCUS14242

10. Russin J, Spetzler R. Commentary: the ARUBA trial. Neurosurgery. 2014;75(1):E96–97, 10.1227/NEU.0000000000000357