Clinical Improvement after Extracranial Venoplasty in Multiple Sclerosis
Clinical Improvement after Extracranial Venoplasty in Multiple Sclerosis
Purpose
This study proposed to prospectively evaluate safety and clinical changes in outpatient endovascular treatment in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI).
Materials and Methods
Two hundred fifty-nine patients with MS were followed with the Multiple Sclerosis Impact Scale (MSIS-29) before and for 1and 6 months after treatment of extracranial internal jugular vein and azygos vein stenoses and occlusions using venous angioplasty, as well as stent placement in 2.5% of patients. Before treatment, the patients were tested with magnetic resonance (MR) venography and flow quantification.
Results
We found statistically significant improvements in the MSIS-29 scores (P < .01) at both 1 and 6 months. At 1 and 6 months, 67.9% and 53.6% were improved on the physical scale, respectively, and 53.0% and 44.4% were improved on the psychological scale, respectively. Women showed greater improvement than did men on the physical scale at 6 months (P = .01). Patients with primary progressive MS (PPMS) showed less improvement than did those with relapsing-remitting MS (RRMS) on the psychological scale at 1 month, and venoplasty treatment of more vein sites versus fewer vein sites showed greater improvement on the physical scale at both 1 and 6 months. Fifteen patients (6.3%) reported recurrent symptoms after clinical improvement and were treated again. There was one serious adverse event, a deep venous thrombosis at the catheter insertion site, which resolved with treatment.
Conclusions
Endovascular treatment of CCSVI in patients with MS appears to be a safe procedure resulting in significant clinical improvement.
Full Article- http://www.jvir.org/article/S1051-0443%2812%2900708-7/abstract
Abbreviations: CCSVI, chronic cerebrospinal venous insufficiency, MS, multiple sclerosis, MSIS-29, Multiple Sclerosis Impact Scale 29, PPMS, primary progressive multiple sclerosis, RRMS, relapsing-remitting multiple sclerosis, SD, standard deviation, SPMS, secondary progressive multiple sclerosis