Carotid and Neurovascular Disease and Intervention
Published online 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.
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