In 2014, A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) concluded that medical management alone for cranial arteriovenous malformations (AVMs) had better clinical outcomes than interventional treatment. The impact of the ARUBA study on changes in the rates of intervention and outcomes is unknown. Thus, we investigated whether the conclusions from ARUBA may have influenced treatment modalities and outcomes of unruptured AVMs. Methods The National Inpatient Sample

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... was queried between 2006 to 2018, for adult patients with an AVM who were admitted on an elective basis. Interventions included open, endovascular, and stereotactic surgeries. Logistic regression was conducted to assess treatment rate for each modality before and after the time-point, odds of non-routine discharge and hemorrhage between the two time-points. Linear regression was used to assess mean LOS between the two timepoints. Results A total of 40,285 elective admissions for AVMs were identified between 2006 and 2018. The rate of intervention was higher pre-ARUBA (n=15,848; 63.8%) compared to post-ARUBA (n=6,985;45.2%; p<0.001). The rate of open, endovascular, and stereotactic surgeries decreased after the ARUBA Trial time-point (ORs: 0.37, 0.69, and 0.18, respectively; p<0.001). For admissions involving interventions, the odds of non-routine discharge were higher post-ARUBA (OR: 1.24; p=0.043); the odds of hemorrhage were lower post-ARUBA (OR: 0.69; p=0.025). There was no statistical difference in length of stay between the two time-points (p=0.22).