Multiple Sclerosis and CCSVI: still a debate among researchers

Alessandro Rasman

It took place in Munich (Germany) September 10 to 14, Congress "CIRSE 2011", Cardiovascular and Interventional Radiological Society of Europe.

One of the hot topics under discussion concerned the research of CCSVI in Multiple Sclerosis by Dr. Paolo Zamboni, Director of Vascular Diseases Center, University of Ferrara and the Symposium was titled "Is CCSVI a real entity? Should we treat MS patients with CCSVI by venoplasty?" moderators: Dierk Vorwerk of Ingolstadt Clinic (Germany) and Jan Peregrin, Masaryk University in Brno (Czech Republic).

On this topic there was a debate between competing views that the audience was very interested in a really crowded room

The first speech of Dr. Günter Ochs, a neurologist at the Ingolstadt Clinic (Germany) presented an introductory report on the MS entitled "The Neurologist's view: basics and clinical signs of MS'' focused on the hypothesis of an autoimmune disease and the drugs currently available (interferons, glatiramer acetate, mitoxantrone, natalizumab) and those soon to be released (alemtuzumab, daclizumab).

The sonologist Dr. Florian Doepp, University Charité Berlin has presented a critical report entitled "Venous congestion in CCSVI: research data" which summarizes the data published so far on CCSVI and provided the results of two studies that deny their causal relationship between chronic cerebro-spinal venous insufficiency and multiple sclerosis.

Dr. Michael Dake, an interventional radiologist at Stanford University (USA) subsequently submitted a report for the correlation between CCSVI and Multiple Sclerosis entitled ''CCSVI is real and we should treat MS patients by venoplasty''. Highlighting the difficulties existing in the U.S. trial, Dr Dake has appealed strongly to CIRSE will soon be prepared in Europe for a randomized controlled trial on the subject CCSVI.

Finally, Dr. Jim. A. Reekers, University of Amsterdam (Netherlands) presented a report entitled "There is no evidence for CCSVI or its treatment in MS patients" which, by reference to a publication of 2009 entitled "No surgical innovation without evaluation: the IDEAL recommendations'' has confirmed the concept already expressed in its title.

On the sidelines of the Symposium were instead presented three interesting posters that, despite having less prominence among the audience, confirmed a possible correlation between the MS and CCSVI.

An Italian team of the University "La Sapienza" of Rome presented two posters, the first titled' ''Evaluation of hemodynamic changes using dynamic susceptibility contrast-enhanced (DSC) MRI in patients with MS and Zamboni’s CCSVI''. According to the authors of the study MS+CCSVI+ patients show CBF and CBV anomalies at multiple levels in the NAWM, both with respect to controls and MS+CCSVI-.

In a second study, titled ''Usefulness of IVUS in diagnosis of chronic cerebrospinal venous insufficiency and multiple sclerosis" the authors concluded that IVUS is a useful device to detect venous anomalies in CCSVI. Particularly it allows a complete evaluation of valve movement that could not be performed with flebographic control. Moreover, it is fundamental to evaluate the Azygos vein structure that could not be showed clearly with US Doppler.

A third and final poster presented by a team of researchers from Argentina, entitled "Initial experience treating chronic cerebro spinal venous insufficiency (CCSVI): preliminary results in 15 patients" where the authors concluded that CCSVI has close relation with MS and venous angioplasty can be used safely with excellent tolerance to improve MS symptoms. In some patients, disabilities relief after balloon angioplasty may be limited because of restenosis and/or other still unknown mechanism.

The debate on the relationship between the Multiple Sclerosis and CCSVI continues and we hope that researchers wll find a common summary of a topic that may revolutionize the knowledge of this disease so debilitating, affecting primarily young people between the 20 and 40 years, with a higher incidence among women.

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