Safety and complications related to endovascular treatment for chronic cerebrospinal venous insufficiency in multiple sclerosis patients. M. Simka, T. Ludyga, M. Kazibudzki, M. Hartel, M. Swierad, J. Piegza, P. Latacz, L. Sedlak, M. Tochowicz

EUROMEDIC Specialist Clinics (Katowice, PL); Magnetic Resonance Imaging Department VOXEL (Zabrze, PL)

Purpose:

The aim of this report is to assess the safety of endovascular treatment for chronic cerebrospinal venous insufficiency (CCSVI). Although balloon angioplasty and stenting in other vascular territories are already accepted and seem to be safe procedures, there are currently no data on such treatments of a large group of patients with compromised venous outflow in the internal jugular (IJV) and/or the azygous vein (AV).

Methods:

A total of 587 endovascular procedures: 414 balloon angioplasties and 173 stent implantations were performed during 361 interventions in 347 CCSVI patients with associated multiple sclerosis.

Results:

There were only few, rather minor and occasional complications or technical problems related to the procedures. These included: (i) life threatening complications: death – 0, major hemorrhage – 0; cerebral stroke – 0; stent migration – 0; (ii) major complications: early stent thrombosis – 2 (1.2%) (all two occlusions occurred after the stenting for severely hypoplastic internal jugular vein; there were no likely clinical consequences due to these thrombotic events because the veins were not patent before the procedures, and the hemodynamics did not worsen despite the unsuccessful stenting); postoperative false aneurysm in the groin – 2 (0.6%) (successfully treated with thrombin injection); surgical procedure (opening of femoral vein) to remove angioplastic balloon – 1 (0.3%); injury to the nerves – 0; (iii) minor complications: transient cardiac arrhythmia – 2 (0.6%); minor bleeding from the groin – 2 (0.6%); minor gastrointestinal bleeding – 1 (0.3%); postprocedural lymphatic cyst in the groin – 1 (0.3%); problems with the removal of angioplastic balloon or delivery system – 5 (0.9%); unsuccessful catheterization of the stenosed internal jugular vein – 4 (0.7%).

Conclusion:

Regardless of the actual impact of the endovascular treatments for venous pathology on the clinical course of multiple sclerosis, which warrants more clinical studies and long term followups, these procedures appeared to be safe and well tolerated by the patients.