Carotid and Neurovascular Disease and Intervention
October 23, 2012
Copyright 2012, American College of Cardiology Foundation. All Rights Reserved.
Chronic cerebrospinal venous insufficiency (CCSVI) characterized by stenoses or obstructions of the internal jugular veins (IJV) and/or azygos vein (AZY), has been reported to be associated with multiple sclerosis (MS). However, such association is a matter of debate. The aim of our retrospective analysis was to determine the relationship between the extent of extracranial venous pathology and clinical severity of MS.
We analyzed 50 consecutive patients (pts) with relapsing-remitting (32 pts) and secondary progressive (18 pts) clinical course of MS (age 38±10 years, M:F=15:35) scheduled for duplex ultrasound (DUS), invasive phlebography, and eventual endovascular procedure of IJV and/or AZY. The extent of stenotic/obstructive process of IJV, and AZY, or IJV reflux, were graded by combination of invasive phlebography and duplex ultrasound as negative (group A), unilateral/focal stenosis/regurgitation (group B), or bilateral/multifocal stenoses/regurgitation (group C). The clinical severity of MS was evaluated by expanded disability disease scoring (EDSS). The study was approved by the local scientific and ethical committee.
Out of 50 analyzed pts (mean EDSS 3.7±2.4) there were 10 pts with negative DUS and venous phlebography pathology (20%), 16 pts with unilateral/focal venous pathology (32%), and 24 pts with bilateral/multifocal pathology (48%). The 20 cases were treated by balloon angioplasty alone, whereas the stenting of at least one vein was required in 14 pts. Importantly, there was significant difference in MS clinical severity of group A versus group B (EDSS 1.8±1.3 vs 3.0±2.2, p<0.05), as well as compare to group C (EDSS group B vs group C 3.0±2.2 vs 5.0±2.2, p<0.005). Similarly, there was significant difference in MS duration in group A versus group C (4±3 years versus 9±5 years, p<0.005).
The clinical severity of multiple sclerosis as well as duration of disease seems to be associated with the extent of pathological venous drainage of the central nervous system. To answer the question if CCSVI is only the accompanying secondary process, or the underlying condition of MS, the blinded randomized studies are needed.
Please read the other comments before posting. Contributors must reveal any conflict
Comments are moderated and will appear on the site at the discretion of The American College of Cardiology editorial staff.
* = Required Field
Disclosure of Any Conflicts of Interest* (applies
to the past 5 years and foreseeable future) Indicate any potential conflicts of
interest of each author below, including specific financial interests and relationships
and affiliations relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria, speakers
bureau, stock ownership or options, expert testimony, royalties, donation of medical
equipment, or patents filed, received, or pending). If all authors have none, check
"No potential conflicts or relevant financial interests" in the box below. Please
also indicate any funding received in support of this work. The information will
be posted with your response.
You don’t need to be a member of the ACC, but you do need to complete a brief registration on CardioSource
before you can sign-up for eTOC alerts (weekly email with the JACC table of contents and weekly email with Online Before Print articles.)
Subscribe to the Journal of the American College of Cardiology for full-text access to content