Neurological Sciences

, Volume 34, Issue 3, pp 269–279 | Cite as

CCSVI and MS: no meaning, no fact

  • Claudio Baracchini
  • Matteo AtzoriEmail author
  • Paolo Gallo
Review Article


A condition called “chronic cerebrospinal venous insufficiency” (CCSVI) has been postulated to play a role in the pathogenesis of multiple sclerosis (MS). This hypothesis implies that a complex pattern of extracranial venous stenosis determines a venous reflux into the brain of MS patients, followed by increased intravenous pressure, blood–brain barrier breakdown and iron deposition into the brain parenchyma, thus triggering a local inflammatory response. In this review, we critically analyze the scientific basis of CCSVI, the current literature on the relationship between CCSVI and MS, as well as the ultrasound methodology that has been claimed to provide evidence of impaired cerebral venous drainage. We show that no piece of the CCSVI theory has a solid supportive scientific evidence. The CCSVI appears to be a rather alien condition and its existence should be definitely questioned. Finally, no proven (i.e., based on strict scientific methodology and on the rules of evidence-based medicine) therapeutic effect of the “liberation” procedure (unblocking the extracranial venous obstruction using angioplasty) has been shown up to date.


CCSVI Multiple sclerosis 


Conflict of interest

Dr. C. Baracchini serves on the executive committee of the European Societyof Neurosonology and Cerebral Hemodynamics; has received funding for travel and speaker honoraria from Pfizer-Inc, Sanofi-Aventis, Laboratori-Guidotti S.P.A. and Novartis; serves as an Associate Editor for BMC Neurology. Dr. M. Atzori reports no conflict of interests. Prof. P. Gallo serves on scientific advisory boards for and has received funding for travel or speaker honoraria from Biogen-Idec, Merck-Serono, Bayer-Schering-Pharma, Sanofi-Aventis, and Novartis; and receives research support fromBiogen-Idec, Merck-Serono, Bayer-Schering-Pharma, Sanofi-Aventis, Novartis and the Italian Ministry of Public Health.


  1. 1.
    Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Tacconi G, Dall’ara S, Bartolomei I, Salvi F (2009) Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 80:392–399PubMedCrossRefGoogle Scholar
  2. 2.
    Zamboni P (2006) The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med 99:589–593PubMedCrossRefGoogle Scholar
  3. 3.
    Singh AV, Zamboni P (2009) Anomalous venous blood flow and iron deposition in multiple sclerosis. J Cereb Blood Flow Metab 29:1876–1878CrossRefGoogle Scholar
  4. 4.
    Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Gianesini S, Bartolomei I, Mascoli F, Salvi F (2009) A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 50:1348–1358PubMedCrossRefGoogle Scholar
  5. 5.
    Bartolomei I, Salvi F, Galeotti R, Salviato E, Alcanterini M, Menegatti E, Mascalchi M, Zamboni P (2010) Hemodynamicpatterns of chroniccerebrospinalvenousinsufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course. Int Angiol 29(2):183–188PubMedGoogle Scholar
  6. 6.
    Baracchini C, Perini P, Calabrese M, Causin F, Rinaldi F, Gallo P (2011) No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol 69:90–99PubMedCrossRefGoogle Scholar
  7. 7.
    Baracchini C, Perini P, Causin F, Calabrese M, Rinaldi F, Gallo P (2011) Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency. Neurology 77:844–850PubMedCrossRefGoogle Scholar
  8. 8.
    Centonze D, Floris R, Stefanini M, Rossi S, Fabiano S, Castelli M, Marziali S, Spinelli A, Motta C, Garaci FG, Bernardi G, Simonetti G (2011) Proposed CCSVI criteria do notpredict MS risk or severity. Ann Neurol 70(1):52–59CrossRefGoogle Scholar
  9. 9.
    Doepp F, Paul F, Valdueza JM, Schmierer K, Schreiber SJ (2010) No cerebrocervical venous congestion in patients with multiple sclerosis. Ann Neurol 68:173–183PubMedGoogle Scholar
  10. 10.
    Doepp F, Wuerfel JT, Pfueller CF, Valdueza JM, Petersen D, Paul F, Schreiber SJ (2011) Venous drainage in multiple sclerosis: a combined magnetic resonance venography and duplex ultrasound study. Neurology 77(19):1745–1751PubMedCrossRefGoogle Scholar
  11. 11.
    Krogias C, Schroder A, Wiendl H, Hohlfeld R, Gold R (2010) Chronic cerebrospinal venous insufficiency’ and multiple sclerosis: critical analysis and first observation in an unselected cohort of MS patients. Nervenarzt 81:740–746PubMedCrossRefGoogle Scholar
  12. 12.
    Mayer CA, Pfeilschifter W, Lorenz MW, Nedelmann M, Bechmann I, Steinmetz H, Ziemann U (2011) The perfect crime? CCSVI not leaving a trace in MS. J Neurol Neurosurg Psychiatry 82(4):436–440PubMedCrossRefGoogle Scholar
  13. 13.
    Mayer CA, Ziemann U (2011) CCSVI: is blinding the key? Eur J Vasc Endovasc Surg 24:536–546Google Scholar
  14. 14.
    Meyer-Schwickerath R, Haug C, Hacker A, Fink F, Seidel D, Hartung HP, Haupts MR (2011) Intracranial venous pressure is normal in patients with multiple sclerosis. MultScler 17(5):637–638Google Scholar
  15. 15.
    Sundstrom P, Wahlin A, Ambarki K, Birgander R, Eklund A, Malm J (2010) Venous and cerebrospinal fluid flow in multiple sclerosis: a case-control study. Ann Neurol 68:255–259PubMedCrossRefGoogle Scholar
  16. 16.
    Tanaka M, Uchizumi H, Tanaka K (2011) Evaluation of blood flow and the cross-sectional area of internal jugular vein in Japanese multiple sclerosis and neuromyelitisoptica patients. Rinsho Shinkeigaku 51:430–432PubMedCrossRefGoogle Scholar
  17. 17.
    Wattjes MP, Van Oosten BW, De Graaf WL, Seewann A, Bot JC, Van Den Berg R, Uitdehaag BM, Polman CH, Barkhof F (2010) No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow quantification study. J Neurol Neurosurg Psychiatry 82(4):429–435PubMedCrossRefGoogle Scholar
  18. 18.
    Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, Wadih A, Awdeh H, Muallem N, Raad R, Al-Kutoubi A (2010) Extracranial venous stenosis is an unlikely cause of multiple sclerosis. Mult Scler 16:1341–1348PubMedCrossRefGoogle Scholar
  19. 19.
    Zivadinov R, Lopez-Soriano A, Weinstock-Guttman B, Schirda CV, Magnano CR, Dolic K, Kennedy CL, Brooks CL, Reuther JA, Hunt K, Andrews M, Dweyer MG, Hojnacki DW (2011) Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects. Radiology 258:562–570PubMedCrossRefGoogle Scholar
  20. 20.
    Zamboni P, Galeotti R (2010) The chronic cerebrospinal venous insufficiency syndrome. Phebology 25:269–279CrossRefGoogle Scholar
  21. 21.
    Chafe R, Born KB, Slutsky AS, Laupacis A (2011) The rise of people power. Nature 472(7344):410–411PubMedCrossRefGoogle Scholar
  22. 22.
    Putnam TJ (1935) Evidences of vascular occlusion in multiple sclerosis and encephalomyelitis. Arch Neurol Neuropsychol 32:1298–1321Google Scholar
  23. 23.
    Putnam TJ (1941) Newer conceptions of postinfectious and related forms of encephalitis. Bull N Y Acad Med 17:337–347PubMedGoogle Scholar
  24. 24.
    Putnam TJ, Alexander L (1939) Disseminated encephalomyelitis. A histologic syndrome associated with thrombosis of small cerebral vessels. Arch Neurol Psych 41:1087–1110CrossRefGoogle Scholar
  25. 25.
    Putnam TJ, Chiavacci LV, Hoff H, Weitzen HG (1947) Results of treatment of multiple sclerosis with dicoumarin. Arch Neurol Psych 57:1–13CrossRefGoogle Scholar
  26. 26.
    Putnam TJ, McKenna JB, Morrison LR (1931) Studies in multiple sclerosis: the histogenesis of experimental sclerotic plaques and their relation to multiple sclerosis. JAMA 97:1591–1596CrossRefGoogle Scholar
  27. 27.
    Adams CW (1988) Perivascular iron deposition and other vascular damage in multiple sclerosis. J Neurol Neurosurg Psychiatry 51:260–265PubMedCrossRefGoogle Scholar
  28. 28.
    Adams C (1989) Vascular aspects of multiple sclerosis. In: Adams C (ed) A colour atlas of multiple sclerosis and other myelin disorders. Woolfe Medical Publication, London, pp 184–187Google Scholar
  29. 29.
    Wakefield AJ, More LJ, Difford J, McLaughlin JE (1994) Immunohistochemical study of vascular injury in acute multiple sclerosis. J Clin Pathol 47:129–133PubMedCrossRefGoogle Scholar
  30. 30.
    Talley C, Talley C (2003) The treatment of multiple sclerosis in Los Angeles and the United States, 1947-1960. Bull Hist Med 77:874–899PubMedCrossRefGoogle Scholar
  31. 31.
    Scheinker M (1949) Recent advances in research and treatment of multiple sclerosis. Ohio Med 45:27–30PubMedGoogle Scholar
  32. 32.
    Thygesen P (1952) Dicumarol therapy of disseminated sclerosis. UgeskrLaeger 114:1685–1691Google Scholar
  33. 33.
    Schelling F (1986) Damaging venous reflux into the skull or spine: relevance to multiple sclerosis. Med Hypotheses 21(2):141–148PubMedCrossRefGoogle Scholar
  34. 34.
    Atkinson W, Forghani R, Wojtkiewicz GR, Pulli B, Iwamoto Y, Ueno T, Waterman P, Truelove J, Oklu R, Chen JW (2012) Ligation of the jugular veins does not result in brain inflammation or demyelination in mice. PLoS ONE 7(3):e3367CrossRefGoogle Scholar
  35. 35.
    Hammond KE, Metcalf M, Carvajal L, Okuda DT, Srinivasan R, Vigneron D, Nelson SJ, Pelletier D (2008) Quantitative in vivo magnetic resonance imaging of multiple sclerosis at 7 Tesla with sensitivity to iron. Ann Neurol 64(6):707–713PubMedCrossRefGoogle Scholar
  36. 36.
    Haacke EM, Garbern J, Miao Y, Habib C, Liu M (2010) Iron stores and cerebral veins in MS studied by susceptibility weighted imaging. Int Angiol 29:149–157PubMedGoogle Scholar
  37. 37.
    Zhang J, Zhang Y, Wang J, Caic P, Luob C, Qiand Z, Daie Y, Fenga H (2010) Characterizing iron deposition in Parkinson’s disease using susceptibility-weighted imaging: an in vivo MR study. Brain Res 1330:124–130PubMedCrossRefGoogle Scholar
  38. 38.
    Smith MA, Zhu X, Tabaton M, Liu G, McKeel DW Jr, Cohen ML, Wang X, Siedlak SL, Dwyer BE, Hayashi T, Nakamura M, Nunomura A, Perry G (2010) Increased iron and free radical generation in preclinical Alzheimer disease and mild cognitive impairment. J Alzheimers Dis 19(1):363–372PubMedGoogle Scholar
  39. 39.
    Kurian MA, McNeill A, Lin J-P, Maher ER (2011) Chilhood disorders of neurodegeneration with brain iron accumulation (NBIA). Dev Med Child Neurol 53:394–404PubMedCrossRefGoogle Scholar
  40. 40.
    Williams R, Rohr AM, Wang WT, Choi IY, Lee P, Berman NE, Lynch SG, LeVine SM (2011) Iron deposition is independent of cellular inflammation in a cerebral model of multiple sclerosis. BMC Neurosci 23:12–59Google Scholar
  41. 41.
    Chandarana H, Lim RP, Jensen JH, Hajdu CH, Losada M, Babb JS, Huffman S, Taouli B (2009) Hepatic iron deposition in patients with liver disease: preliminary experience with breath-hold multiecho T2*-weighted sequence. AJR Am J Roentgenol 193(5):1261–1267PubMedCrossRefGoogle Scholar
  42. 42.
    Winyard PG, Blake DR, Chirico S, Gutteridge JM, Lunec J (1987) Mechanism of exacerbation of rheumatoid synovitis by total-dose iron-dextran infusion: in vivo demonstration of iron-promoted oxidant stress. Lancet 1(8524):69–72PubMedCrossRefGoogle Scholar
  43. 43.
    Barnham KJ, Bush AI (2008) Metals in Alzheimer’s and Parkinson’s diseases. Curr Opin Chem Biol 12(2):222–228PubMedCrossRefGoogle Scholar
  44. 44.
    Bush AI, Curtain CC (2008) Twenty years of metallo-neurobiology: where to now? Eur Biophys J 37(3):241–245 Epub 2007 Nov 10PubMedCrossRefGoogle Scholar
  45. 45.
    Craelius W, Migdal MW, Luessenhop CP, Sugar A, Mihalakis I (1982) Iron deposits surrounding multiple sclerosis plaques. Arch Pathol Lab Med 106(8):397–399PubMedGoogle Scholar
  46. 46.
    Walton JC, Kaufmann JC (1984) Iron deposits and multiple sclerosis. Arch Pathol Lab Med 108(9):755–756PubMedGoogle Scholar
  47. 47.
    Levine SM, Chakrabarty A (2004) The role of iron in the pathogenesis of experimental allergic encephalomyelitis and multiple sclerosis. Ann N Y Acad Sci 1012:252–266PubMedCrossRefGoogle Scholar
  48. 48.
    Burgetova A, Seidl Z, Krasensky J, Horakova D, Vaneckova M (2010) Multiple sclerosis and the accumulation of iron in the basal ganglia: quantitative assessment of brain iron using MRI t(2) relaxometry. Eur Neurol 63(3):136–143PubMedCrossRefGoogle Scholar
  49. 49.
    Khalil M, Langkammer C, Ropele S, Petrovic K, Wallner-Blazek M, Loitfelder M, Jehna M, Bachmaier G, Schmidt R, Enzinger C, Fuchs S, Fazekas F (2011) Determinants of brain iron in multiple sclerosis: a quantitative 3T MRI study. Neurology 77:1691–1697PubMedCrossRefGoogle Scholar
  50. 50.
    Ropele S, de Graaf W, Khalil M, Wattjes MP, Langkammer C, Rocca MA, Rovira A, Palace J, Barkhof F, Filippi M, Fazekas F (2011) MRI assessment of iron deposition in multiple sclerosis. J Magn Reson Imaging. 34(1):13–21PubMedCrossRefGoogle Scholar
  51. 51.
    Calabrese M, Rinaldi F, Grossi P, Mattisi I, Bernardi V, Favaretto A, Perini P, Gallo P (2010) Basalganglia and frontal/parietal cortical atrophy is associated with fatigue in relapsing-remitting multiple sclerosis. Mult Scler 16(10):1220–1228PubMedCrossRefGoogle Scholar
  52. 52.
    Téllez N, Alonso J, Río J, Tintoré M, Nos C, Montalban X, Rovira A (2008) The basalganglia: a substrate for fatigue in multiple sclerosis. Neuroradiology 50(1):17–23PubMedCrossRefGoogle Scholar
  53. 53.
    Niepel G, TenchChR MorganPS, Evangelou N, Auer DP, Constantinescu CS (2006) Deep gray matter and fatigue in MS: a T1 relaxation time study. J Neurol 253(7):896–902PubMedCrossRefGoogle Scholar
  54. 54.
    Ropele S, de Graaf W, Khalil M, Wattjes MP, Langkammer C, Rocca MA, Rovira A, Palace J, Barkhof F, Filippi M, Fazekas F (2011) MRI assessment of iron deposition in multiple sclerosis. J Magn Res Imaging 34:13–21CrossRefGoogle Scholar
  55. 55.
    Hayflick SJ (2006) Neurodegeneration with brain iron accumulation: from genes to pathogenesis. Sem Ped Neurol 13:182–185CrossRefGoogle Scholar
  56. 56.
    Schipper HM (2012) Neurodegeneration with brain iron accumulation: clinical syndromes and neuroimaging. Bioch Bioph Acta 1822:350–360CrossRefGoogle Scholar
  57. 57.
    Worthington V, Killestein J, Eikelenboom MJ, Teunissen CE, Barkhof F, Polman CH, Uitdehaag BM, Petzold A (2010) Normal CSF ferritin levels in MS suggest against etiologic role of chronic venous insufficiency. Neurology 75:1617–1622PubMedCrossRefGoogle Scholar
  58. 58.
    Adams CW, Poston RN, Buk SJ (1989) Pathology, histochemistry and immunocytochemistry of lesions in acute multiple sclerosis. J NeurolSci 92:291–306Google Scholar
  59. 59.
    West JB, Tsukimoto K, Matheu-Costello O, Prediletto R (1991) Stress failure in pulmonary capillaries. J Appl Physiol 70:1731–1742PubMedGoogle Scholar
  60. 60.
    Adams RA, Passino M, Sachs BD, Nuriel T, Akassoglou K (2004) Fibrin mechanisms and functions in the nervous system. Mol Interv 4:163–176PubMedGoogle Scholar
  61. 61.
    Adams RA, Bauer J, Flick MJ, Sikorski SL, Nuriel T, Lassmann H, Degen JL, Akassoglou K (2007) The fibrin-derived γ377-395 peptide inhibits microglia activation and suppresses relapsing paralysis in central nervous system autoimmune disease. J Exp Med 204:571–582PubMedCrossRefGoogle Scholar
  62. 62.
    Ostergaard L, Weisskoff RM, Chesler DA, Gyldensted C, Rosen BR (1996) High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysis. Magn Reson Med 36(5):715–725PubMedCrossRefGoogle Scholar
  63. 63.
    Ostergaard L, Sorensen AG, Kwong KK, Weisskoff RM, Gyldensted C, Rosen BR (1996) High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part II: Experimental comparison and preliminary results. MagnReson Med 36(5):726–736CrossRefGoogle Scholar
  64. 64.
    Calamante F, Gadian DG, Connelly A (2002) Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use. Stroke 33(4):1146–1151PubMedCrossRefGoogle Scholar
  65. 65.
    Law M, Saindane AM, Ge Y, Law M, Saindane AM, Ge Y, Babb JS, Johnson G, Mannon LJ, Herbert J, Grossman RI (2004) Microvascular abnormality in relapsing-remitting multiple sclerosis: perfusion MR imaging findings in normal-appearing white matter. Radiology 231:645–652PubMedCrossRefGoogle Scholar
  66. 66.
    Adhya S, Johnson G, Herbert J, Jaggi H, Babb JS, Grossman RI, Inglese M (2006) Pattern of hemodynamic impairment in multiple sclerosis: dynamic susceptibility contrast perfusion MR imaging at 3.0 T. Neuroimage 33(4):1029–1035PubMedCrossRefGoogle Scholar
  67. 67.
    Haselhorst R, Kappos L, Bilecen D, Scheffler K, Möri D, Radü EW, Seelig J (2000) Dynamic susceptibility contrast MR imaging of plaque development in multiple sclerosis: application of an extended blood-brain barrier leakage correction. J Magn Reson Imaging 11(5):495–505PubMedCrossRefGoogle Scholar
  68. 68.
    Wuerfel J, Bellmann-Strobl J, Brunecker P, Aktas O, McFarland H, Villringer A, Zipp F (2004) Changes in cerebralperfusion precede plaque formation in multiple sclerosis: a longitudinal perfusion MRI study. Brain 127(Pt 1):111–119PubMedCrossRefGoogle Scholar
  69. 69.
    Ge Y, Law M, Johnson G, Herbert J, Babb JS, Mannon LJ, Grossman RI (2005) Dynamic susceptibility contrast perfusion MR imaging of multiple sclerosis lesions: characterizing hemodynamic impairment and inflammatory activity. AJNR Am J Neuroradiol 26(6):1539–1547PubMedGoogle Scholar
  70. 70.
    Auriel E, Karni A, Bornstein NM, Nissel T, Gadoth A, Hallevi H (2011) Extra-cranial venous flow in patients with multiple sclerosis. J Neurol Sci 309(1–2):102–104PubMedCrossRefGoogle Scholar
  71. 71.
    Tsivgoulis G, Mantatzis M, Bogiatzi C, Vadikolias K, Voumvourakis K, Prassopoulos P, Piperidou C, Heliopoulos I (2011) Extracranial venous hemodynamics in multiple sclerosis: a case-control study. Neurology 77(13):1241–1245PubMedCrossRefGoogle Scholar
  72. 72.
    Bastianello S, Romani A, Viselner G, Tibaldi EC, Giugni E, Altieri M, Cecconi P, Mendozzi L, Farina M, Mariani D, Galassi A, Quattrini C, Mancini M, Bresciamorra V, Lagace A, McDonald S, Bono G, Bergamaschi R (2011) Chroniccerebrospinalvenousinsufficiency in multiple sclerosis: clinical correlates from a multi centre study. BMC Neurol 11:132PubMedCrossRefGoogle Scholar
  73. 73.
    Dolic K, Marr K, Valnarov V, Dwyer MG, Carl E, Karmon Y, Kennedy C, Brooks C, Kilanowski C, Hunt K, Siddiqui AH, Hojnacki D, Weinstock-Guttman B, Zivadinov R (2012) Intra- and extraluminal structural and functional venous anomalies in multiple sclerosis, as evidenced by 2 noninvasive imaging techniques. AJNR Am J Neuroradiol 33(1):16–23PubMedCrossRefGoogle Scholar
  74. 74.
    Nedelmann M, Eicke BM, Dieterich M (2005) Functional and morphological criteria of internal jugular valve insufficiency as assessed by ultrasound. J Neuroimaging 15:70–75PubMedGoogle Scholar
  75. 75.
    Stolz E, Kaps M, Dorndorf W (1999) Assessment of intracranial venous hemodynamics in normal individuals and patients with cerebral venous throm-bosis. Stroke 30:70–75PubMedCrossRefGoogle Scholar
  76. 76.
    Valdueza JM, von Münster T, Hoffmann O, Schreiber S, Einhäupl KM (2000) Postural dependency of the cerebral venous outflow. Lancet 355:200–201PubMedCrossRefGoogle Scholar
  77. 77.
    Hoffmann O, Weih M, Einhäupl KM, Valdueza JM (1999) Normal blood flow velocities in the vertebral veins. J Neuroimaging 9:198–201PubMedGoogle Scholar
  78. 78.
    Van Bemmelen PS, Bedford G, Beach K, Strandness DE (1989) Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning. J VascSurg 10:425–431Google Scholar
  79. 79.
    Sarin S, Sommerville K, Farrah J, Scurr JH, Coleridge Smith PD (1994) Duplex ultrasonography for assessment of venous valvular function of the lower limb. Br J Surg 81:1591–1595PubMedCrossRefGoogle Scholar
  80. 80.
    Lichtenstein D, Saifi R, Augarde R, Prin S, Schmitt JM, Page B, Pipien I, Jardin F (2001) The Internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization. Intensive Care Med 27:301–305PubMedCrossRefGoogle Scholar
  81. 81.
    Zamboni P, Galeotti R, Weinstock-Guttman B, Kennedy C, Salvi F, Zivadinov R (2012) Venous angioplasty in patients with multiple sclerosis: results of a pilot study. Eur J Vasc Endovasc Surg 43(1):116–122PubMedCrossRefGoogle Scholar
  82. 82.
    Kostecki J, Zaniewski M, Ziaja K, Urbanek T, Kuczmik W, Krzystanek E, Ziaja D, Korzeniowski T, Majewski E, Hartel M, Swiat M, Sioma-Markowska U (2011) An endovascular treatment of chronic cerebro-spinal venous Insufficiency in multiple sclerosis patients: 6 month follow-up results. Neuro Endocrinol Lett 32(4):557–562PubMedGoogle Scholar
  83. 83.
    Reekers JA (2012) CCSVI and MS: a never-ending story. Eur J Vasc Endovasc Surg 43(1):127–128PubMedCrossRefGoogle Scholar
  84. 84.
    Burton JM, Alikhani K, Goyal M, Costello F, White C, Patry D, Bell R, Hill MD (2011) Complications in MS patients after CCSVI procedures abroad (Calgary, AB). Can J Neurol Sci 38(5):741–746PubMedGoogle Scholar
  85. 85.
    Imperial College CCSVI Investigation Group, Thapar A, Lane TR, Pandey V, Shalhoub J, Malik O, Ellis M, Franklin IJ, Nicholas R, Davies AH (2011) Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency. Phlebology 26(6):254–256PubMedCrossRefGoogle Scholar
  86. 86.
    Samson K (2010) Experimental multiple sclerosis vascular shunting procedure halted at Stanford. Ann Neurol 67:A13–A15CrossRefGoogle Scholar
  87. 87.
    Mandato KD, Hegener PF, Siskin GP, Haskal ZJ, Englander MJ, Garla S, Mitchell N, Reutzel L, Doti C (2012) Safety of endovascular treatment of chronic cerebrospinal venous insufficiency: a report of 240 patients with multiple sclerosis. J Vasc Interv Radiol 23(1):55–59PubMedCrossRefGoogle Scholar
  88. 88.
    Ludyga M, Kazibudzki M, Simka M, Hartel M, Swierad M, Piegza J, Latacz P, Sedlak L, Tochowicz M (2010) Endovascular treatment for chronic cerebrospinal venous insufficiency: is the procedure safe? Phlebology 25:286–295PubMedCrossRefGoogle Scholar
  89. 89.
    Vedantham S, Benenati JF, Kundu S et al (2010) Interventional endovascular management of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis: a position statement by the society of interventional radiology, endorsed by the Canadian interventional radiology association. J Vasc Interv Radiol 21:1335–1337PubMedCrossRefGoogle Scholar
  90. 90.
    Reekers JA, Lee MJ, Belli AM (2011) Cardiovascular and interventional radiological society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency. Cardiovasc Intervent Radiol 34:1–2PubMedCrossRefGoogle Scholar
  91. 91.
    Krogias C, Clanet M, Comi C, Gold R, Lernzi GL, Montalban X, Sorensen PS (2011) Chronic Cerebrospinal Venous Insufficiency (CCSVI) in Multiple Sclerosis. From “The Big Idea” to “The Perfect Crime”? Joint Statement of EFNS- and ENS Multiple Sclerosis Scientist Panel and ECTRIMS Executive Committee, 4/2011Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Claudio Baracchini
    • 1
  • Matteo Atzori
    • 2
    Email author
  • Paolo Gallo
    • 2
  1. 1.Department of Neuroscience-SSPNRRStroke Unit, First Neurology Clinic, University of PadovaPaduaItaly
  2. 2.Department of Neuroscience-SSPNRRMultiple Sclerosis Centre of the Veneto Region, First Neurology Clinic, University of PadovaPaduaItaly

Personalised recommendations