The abstract below contains the most important information on CCSVI being presented at ECTRIMS. Many other worthless Doppler studies are being presented and, not surprisingly, most found little to no CCSVI. A sad tale of incompetent operators finding what their neurological masters want.

Comparison of intravascular ultrasound to gold standard catheter venography for detection of extra-cranial venous abnormalities indicative of CCSVI: results of the PREMiSe (Prospective Randomized Endovascular therapy in Multiple Sclerosis) study

Y. Karmon, R. Zivadinov, B. Weinstock-Guttman, K. Dolic, C. Kennedy, K. Marr, V. Valnarov, A. Siddiqui (Buffalo, US)

Background: A combination of 5 Doppler Sonography (DS) criteria was proposed for diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis (MS). A subject was considered CCSVI positive if >=2 venous hemodynamic (VH) criteria were fulfilled. A number of recent studies evaluated accuracy of the DS criteria against the “gold standard” catheter venography (CV) with discrepant findings. Despite being used as a gold standard for assessing vascular problems, CV only provides luminography, with little or no data on the vessel's wall or intraluminal structures that are the main characteristics of CCSVI-related venous abnormalities.
Objective: To investigate frequency of extra-cranial abnormalities in the azygos (AZY) and internal jugular veins (IJVs) using CV and intravascular ultrasound (IVUS).
Methods: PREMiSe is an endovascular angioplasty study that enrolled 30 patients with relapsing MS who fulfilled >=2 VH extra-cranial DS criteria at screening. The study was conducted in two phases. Phase I was open label and included 10 MS patients, whereas phase II is placebo-controlled, blinded and randomized, and included 20 MS patients. CV was performed on all AZY and IJVs, while IVUS was performed across suspected stenotic segments (>=50% restriction) of the AZY and IJV's in phase I, and on all vessels in phase II. CV was considered abnormal when >=50% restriction of the lumen was detected. IVUS was considered abnormal when >=50% restriction of the lumen, or intraluminal defects (septa, multiple channeled vein, intraluminal hyperechoic filling defect, double/parallel lumen) or reduced pulsatility were detected.
Results: Out of 22 AZY veins studied with IVUS and CV, 19 (86.4%) showed abnormal finding on IVUS, whereas 12 (44.4%) of those showed abnormal CV. In the left IJV, 21 (84%) out of 25 veins studied with IVUS and CV showed abnormality on IVUS, and 19 (76%) on CV. In the right IJV, 14 (58.3%) out of 24 veins studied with IVUS and CV were abnormal. The most frequent venous abnormalities were the intraluminal ones (86.4%) in the AZY vein, whereas in descending frequency order, reduced pulsatility, stenoses and intraluminal abnormalities were detected in the IJVs.
Conclusions: IVUS assessment of AZY and IJVs showed a higher rate of venous abnormalities compared to CV. IVUS provides a diagnostic advantage over "gold standard" CV in detecting extra-cranial venous abnormalities indicative of CCSVI.