These are two of the papers presented at ECTRIMS 2010--
Here are the abstracts with links for physicians.
The chronic cerebrospinal venous insufficiency syndrome
P Zamboni and R Galeotti
Vascular Disease Centre, Interventional Radiology Unit, University of Ferrara, Italy
Correspondence: P Zamboni MD, University of Ferrara, 44100 Ferrara, Italy. Email:zmp@unife.it
Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized
by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with
opening of collaterals and insufficient drainage proved by reduced
cerebral blood flow and increased mean transit time in cerebral MRI
perfusional study. The present review is aimed to give a comprehensive
overview of the actual status of the art of the diagnosis and treatment
of this condition. As far as the origin of venous narrowing is
concerned, phlebographic studies of the IJVs and AZ systems demonstrated
that venous stenoses were likely to be truncular venous malformations;
mostly, they are intraluminal defects such as malformed valve,
septa webs. CCSVI condition has been found to be strongly
associated with multiple sclerosis (MS), a disabling
neurodegenerative and demyelinating disease considered autoimmune in
nature. In several epidemiological observations performed at
different latitudes on patients with different genetic backgrounds,
theprevalence of CCSVI in MS ranges from 56% to 100%. To the
contrary, by using venous MR and/or different Doppler protocols,
CCSVI was not detected with the same prevalence. Two pilot
studies demonstrated the safety and feasibility in Day Surgery of
the endovascular treatment of CCSVI by means of balloon
angioplasty (PTA). It determines a significant reduction of
postoperative venous pressure. Restenosis rate was found out elevated in
theIJVs, but negligible in the AZ. However, PTA seems to
positively influence clinical and QoL parameters of the associated MS
and warrants further randomized control trials.
http://phleb.rsmjournals.com/cgi/content/abstract/25/6/269
Endovascular treatment for chronic cerebrospinal venous insufficiency: is the procedure safe?
T Ludyga *, M Kazibudzki *, M Simka * , M Hartel , M wierad *,J Piegza *, P Latacz *, L Sedlak * and M Tochowicz *
EUROMEDIC Specialist Clinics, Department of Vascular & Endovascular Surgery,
Katowice; Magnetic Resonance Imaging Department VOXEL, Medical
University Hospital No 1, Zabrze, Poland
Correspondence: M Simka PhD MD, ul. Jednosci 20, 43-245 Studzionka, Poland. Email:mariansimka@poczta.onet.pl
Objectives: The aim of this report is to assess the safety of endovasculartreatment
for chronic cerebrospinal venous insufficiency (CCSVI). Although
balloon angioplasty and stenting seem to be safe procedures, there are
currently no data on the treatment of a large group of patients with
this vascular pathology.
Methods: A total of 564 endovascular procedures (balloon angioplasty or, if this procedure
failed, stenting) were performed during 344 interventions in 331 CCSVI
patients with associated multiple sclerosis.
Results: Balloon angioplasty alone was performed in 192 cases (55.8%), whereas
the stenting of at least one vein was required in the remaining 152
cases (44.2%). There were no major complications (severe bleeding,
venous thrombosis, stent migration or injury to the nerves) related to
the procedure, except for thrombotic occlusion of the stent in two cases
(1.2% of stenting procedures) and surgical opening of femoral vein to
remove angioplasticballoon in one case (0.3% of procedures). Minor
complications included occasional technical problems (2.4% of
procedures): difficulty removing the angioplastic balloon or problems
with proper placement of stent, and other medical events (2.1%
of procedures): local bleeding from the groin, minor
gastrointestinal bleeding or cardiac arrhythmia.
Conclusions: The procedures appeared to be safe and well tolerated by the patients,
regardless of the actual impact of the endovascular treatments for
venous pathology on the clinical course of multiple sclerosis, which
warrants long-term follow-up.
http://www.facebook.com/note.php?note_id=472445562210&id=110796282297
http://phleb.rsmjournals.com/cgi/content/abstract/25/6/286