• Demyelinating Diseases Clinical Trials

Chronic cerebrospinal venous insufficiency (CCSVI) is thought to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). As such, it has generated immense interest in the patient and scientific communities and has also ushered in a potential shift in the treatment paradigm of MS, involving endovascular balloon angioplasty or venous stent placement [Khan O et al. Ann Neurol 2010].

CCSVI is characterized by multiple stenoses of extracranial veins—the internal jugular (IJ) and azygous (AZ) veins. Miro Denišlič, MD, PhD, MC Medicor, d.d., Ljubljana, Slovenia, presented a poster on a clinical trial to highlight the occurrence and effects of obstructions in the extracranial venous system.

A total of 100 MS patients participated in the study. There was no control group. The threshold for angioplasty was a luminal diameter reduction of 50%. Catheter venography (CV) was performed under mild anesthesia.

Results showed that the degree of narrowing in the IJ and AZ veins was similar in the group of MS patients with an early and progressive course of the disease. The number of venous lesions was related to clinical disability. The left IJ vein was more often involved than the right one; narrowing of the AZ vein occurred less frequently (52%).

After angioplasty, patients reported improvements in headaches, vision problems, fatigue, and urinary dysfunction, and fewer spasms. Significant improvement in quality of life was demonstrated. In two patients (2%), CV examination did not reveal any vascular abnormality. No major side effects were reported.

Despite controversies surrounding CCSVI, extracranial venous pathology may play an important role in developing MS. Findings from a recent study on endovascular treatment indicated that the therapy appeared to be a safe and reliable method for treating CCSVI [Petrov I et al. J Endovasc Ther 2011].

Prof. Denišlič and his colleagues concluded that further investigation of timely angioplasty is warranted.

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