CCSVI Update Symposium – Big Issues - facebook prikbord

CCSVI Update Symposium – New York City
Host: Dr. Salvatore Sclafani

by Brock Winterton, President of the CCSVI Coalition

General Impressions:
There was a very strong turnout from the medical scientist point of view with most of the central players in CCSVI present. The exception was Paolo Zamboni, who was scheduled to be there but broke his leg and was unable to attend. A large number of Interventional radiologists were present, seeking to improve their knowledge of the issues and techniques in CCSVI. It was a collegial group that seemed truly interested in sorting out the issues of diagnosis and treatment and progressing the state of science and practice.

One of the more exciting aspects of the presentations was the effect of the greater examination of venous abnormalities on a growing list of indications beyond MS (MS remaining the primary focus). The growth in examination and understanding of venous issues is now being more aggressively examined and the understanding is crossing over into areas like Normal Pressure Hydrocephalus (NPH), Ehler Danos Syndrome, venous Parkinson’s, ALS and dementia. CCSVI will clearly have much to contribute to a wide variety of medical scientific understandings and so should for that reason alone be considered a new and powerful branch of medical science.

More specific to CCSVI, it was clearly evident that with the growing number of procedures completed worldwide, standards of best practice and protocols are emerging. Having gone from an experimental procedure it has now entered a definitional stage that will see procedural standards emerge as well as patient selection standards. New procedural developments include the use of Intra Venous Ultrasound (IVUS) as well as some intriguing uses of stem cell therapy. Also, there was a call for more standardization and greater use of imaging before during and after the procedure. As to patient selection, this relates to the growing knowledge that there are various types of stenosis and each might require different treatment regimes or even no treatment at all. Restenosis treatment selection also was discussed. In summary, it is obvious that CCSVI procedural understanding is maturing and growing in sophistication.

As to the crucial link to MS, the key question many believe, there has been considerable progress in identifying that there is a link between CCSVI and MS, even if there is not a clear understanding as to the mechanisms at work and how CCSVI treatment can reduce relapses, lesions and brain atrophy. The science for understanding these mechanisms has expanded to include such areas as fluid mechanics centred on the crucial issue of how does lack of venous flow lead to hypoxia (lack of oxygen) death of endothelium, compromise of the blood brain barrier and demyelination, perfusion issues in the brain and iron deposition in key brain centres. But it was clear that the understanding of blood flow (drainage) issues has taken great leaps forward in terms of understanding its mechanisms and its potential importance.

While all wanted more studies, there were varying viewpoints as to the nature of studies – focusing on disease markers or symptom relief. While there are some small, pilot, randomized treatment studies being started, design of a study is critical to outcome. What became clear in the seminar was that it takes considerable experience to develop technique and studies that do not include experienced operators will be compromised just as badly as if it were lacking blinding or randomization. Similarly, endpoints that focus on relapse occurrence, lesion progression and brain atrophy are important in adding to progressing the understanding of the disease model.