CRT-300.04 Does An Endovascular Procedure Improve the Quality of Life in Patients With Multiple Sclerosis
J Am Coll Cardiol Intv. 2016

Background
A vascular role in the etiology of multiple sclerosis (MS) has long been discussed. The extracranial stenoses of the jugular (IJV) and azygous (AZY) veins affect the venous drainage as chronic cerebrospinal venous insufficiency (CCSVI). The correlation between MS and CCSVI endeavour to elucidate the role of CCSVI and its influence on the symptoms and the signs of MS.
The primary endpoint of our open-label study was to evaluate quality of life (QoL) of MS patients with CCSVI after the endovascular procedures.

Methods
MS patients were diagnosed by revised McDonald criteria and CCSVI was evaluated by Doppler sonography if 2 or more out of 5 criteria were observed. In patients with suspecting CCSVI the catheter venography was performed. To assess the efficacy of the vascular procedures on QoL, Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), validated Overactive bladder self-administered questionnaire (OAB-V8 Pfizer) and Multiple Sclerosis Impact Scale (MSIS-29) were used. FSS, MFIS,OAB-V8 and MSIS-29 were evaluated at baseline, 3, 6, and 12 months after vascular angioplasty.

Results
In our study 94 consecutive MS patients were included (22 patients with relapsing-remitting, 44 with secondary and 26 with primary progressive course of MS). In two patients (2.1%) venography did not reveal any vascular abnormality. The left IJV was more often affected. The number of venous lesions increases with the degree of disability (p < 0.02). FSS (p < 0.001) and MFIS scores - total score, as well as scores of the three subscales - physical, cognitive and psychosocial significantly improved from baseline values estimated before vascular procedures (p < 0.05). The improvement of the both scales correlated with the degree of pyramidal involvement (p < 0.001). The important improvement of the bladder function using OAB-V8 was demonstrated (p < 0.01). The improvement of QoL assessed by MSIS-29 questionnaire was observed (p < 0.01). The positive trend of all 4 parameters was maintained at one year.

Conclusion
The amelioration of cerebral venous drainage reduce bladder disfunction, the perception of fatigue and increase mental health. Endovascular procedures in MS patients are beneficial and importantly contribute to the improvement of disability and quality of life in MS patients.
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