Neurological Sciences

, Volume 34, Issue 9, pp 1633–1637 | Cite as

Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases

  • A. Ghezzi
  • P. Annovazzi
  • E. Cocco
  • G. Coarelli
  • A. Lugaresi
  • M. Rovaris
  • F. Patti
  • E. Capello
  • M. E. Rodegher
  • L. Moiola
  • S. Malucchi
  • G. Salemi
  • N. De Rossi
  • L. Provinciali
  • P. Perini
  • R. Bergamaschi
  • E. Scarpini
  • G. Lus
  • A. Gallo
  • M. R. Tola
  • M. P. Amato
  • M. R. Rottoli
  • A. Bianchi
  • G. Comi
  • The MS Study Group-Italian Society of Neurology
Original Article

Abstract

Although it is still debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients underwent endovascular treatment (ET) of CCSVI. The objective of the study is to evaluate the outcome and safety of ET in Italian MS patients. Italian MS centers that are part of the Italian MS Study Group were all invited to participate to this retrospective study. A structured questionnaire was used to collect detailed clinical data before and after the ET. Data from 462 patients were collected in 33 centers. ET consisted of balloon dilatation (93 % of cases) or stent application. The mean follow-up duration after ET was 31 weeks. Mean EDSS remained unchanged after ET (5.2 vs. 4.9), 144 relapses occurred in 98/462 cases (21 %), mainly in RR-MS patients. Fifteen severe adverse events were recorded in 3.2 % of cases. Given the risk of severe adverse events and the lack of objective beneficial effects, our findings confirm that at present ET should not be recommended to patients with MS.

Keywords

Multiple sclerosis CCSVI Endovascular treatment 

Supplementary material

10072_2013_1300_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)

References

  1. 1.
    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
  2. 2.
    Zamboni P, Menegatti E, Bartolomei I et al (2007) Intracranial venous haemodynamics in multiple sclerosis. Curr Neurovasc Res 4:252–258PubMedCrossRefGoogle Scholar
  3. 3.
    Zamboni P, Galeotti R, Menegatti E et al (2009) Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 80:392–399PubMedCrossRefGoogle Scholar
  4. 4.
    Zamboni P, Menegatti E, Galeotti R et al (2009) The value of cerebral Doppler venous haemodynamics in the assessment of multiple sclerosis. J Neurol Sci 282:21–27PubMedCrossRefGoogle Scholar
  5. 5.
    Thapar A, Lane T, Nicholas R, Friede T et al (2011) Systematic review of sonographic chronic cerebrospinal venous insufficiency findings in multiple sclerosis. Phlebology 26(8):319–325PubMedCrossRefGoogle Scholar
  6. 6.
    Baracchini C, Atzori M, Gallo P (2012) CCSVI and MS: no meaning, no fact. Neurol Sci May 9 (Epub ahead of print)Google Scholar
  7. 7.
    Bagert BA, Marder E, Stüve O (2011) Chronic cerebrospinal venous insufficiency and multiple sclerosis. Arch Neurol 68:1379–1384PubMedCrossRefGoogle Scholar
  8. 8.
    Kipshidze N, Rukhadze I, Archvadze A et al (2011) Endovascular treatment of patients with chronic cerebrospinal venous insufficiency and multiple sclerosis. Georgian Med News 199:29–34PubMedGoogle Scholar
  9. 9.
    Mandato KD, Hegener PF, Siskin GP et al (2012) Safety of endovascular treatment of chronic cerebrospinal venous insufficiency: a report of 240 patients with multiple sclerosis. J Vasc Interv Radiol 23:55–59PubMedCrossRefGoogle Scholar
  10. 10.
    Kostecki J, Zaniewski M, Ziaja K et al (2011) An endovascular treatment of chronic cerebro-spinal venous insufficiency in multiple sclerosis patients—6 month follow-up results. Neuro Endocrinol Lett 32:557–562PubMedGoogle Scholar
  11. 11.
    Zamboni P, Galeotti R, Weinstock-Guttman B et al (2012) Venous angioplasty in patients with multiple sclerosis: results of a pilot study. Eur J Vasc Endovasc Surg 43:116–122PubMedCrossRefGoogle Scholar
  12. 12.
    Petrov I, Grozdinski L, Kaninski G (2011) Safety profile of endovascular treatment for chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Endovasc Ther 18:314–323PubMedCrossRefGoogle Scholar
  13. 13.
    Ludyga T, Kazibudzki M, Simka M et al (2010) Endovascular treatment for chronic cerebrospinal venous insufficiency: is the procedure safe? Phlebology 25:286–295PubMedCrossRefGoogle Scholar
  14. 14.
    Zamboni P, Galeotti R, Menegatti E et al (2009) A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 50:1348–1358PubMedCrossRefGoogle Scholar
  15. 15.
    Salvi F, Bartolomei I, Buccellato E et al (2012) Venous angioplasty in multiple sclerosis: neurological outcome at two years in a cohort of relapsing-remitting patients. Funct Neurol 27:55–59PubMedGoogle Scholar
  16. 16.
  17. 17.
    Kurtzke JF (1983) Rating neurological impairment in multiple sclerosis: an expanded disability scale (EDSS). Neurology 33:1444–1452PubMedCrossRefGoogle Scholar
  18. 18.
    Ghezzi A. Annovazzi P, Amato MP et al. (2013) Adverse events after endovascular treatment of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis Mult Scler J (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • A. Ghezzi
    • 1
  • P. Annovazzi
    • 1
  • E. Cocco
    • 2
  • G. Coarelli
    • 3
  • A. Lugaresi
    • 4
  • M. Rovaris
    • 5
  • F. Patti
    • 6
  • E. Capello
    • 7
  • M. E. Rodegher
    • 8
  • L. Moiola
    • 8
  • S. Malucchi
    • 9
  • G. Salemi
    • 10
  • N. De Rossi
    • 11
  • L. Provinciali
    • 12
  • P. Perini
    • 13
  • R. Bergamaschi
    • 14
  • E. Scarpini
    • 15
  • G. Lus
    • 16
  • A. Gallo
    • 17
  • M. R. Tola
    • 18
  • M. P. Amato
    • 19
  • M. R. Rottoli
    • 20
  • A. Bianchi
    • 1
  • G. Comi
    • 8
  • The MS Study Group-Italian Society of Neurology
  1. 1.Centro Studi Sclerosi Multipla, Ospedale di GallarateGallarateItaly
  2. 2.Centro Sclerosi Multipla, Dipartimento di Sanità Pubblica, Medicina Clinica e MolecolareUniversity of CagliariCagliariItaly
  3. 3.Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory OrgansSapienza University S. Andrea Hospital-RomeRomeItaly
  4. 4.Multiple Sclerosis Center, Department of Neuroscience and ImagingUniversità “G d’Annunzio” ChietiChietiItaly
  5. 5.Multiple Sclerosis Center, Fondazione Don GnocchiMilanItaly
  6. 6.DANA GF Ingrassia, Neuroscience Section, Multiple Sclerosis CenterUniversity of CataniaCataniaItaly
  7. 7.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaLiguriaItaly
  8. 8.Department of Neurology, San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly
  9. 9.Neurologia 2-CRESM, AOU San Luigi GonzagaOrbassanoItaly
  10. 10.Centro per la “Diagnosi e Cura delle Malattie Demielinizzanti” Dipartimento di Biomedicina Sperimentale e Neuroscienze ClinicheUniversità degli Studi di PalermoPalermoItaly
  11. 11.U.S.D Neurologia, Centro Regionale per la Sclerosi Multipla, Spedali Civili Brescia, Presidio di MontichiariMontichiariItaly
  12. 12.Clinica NeurologicaUniversità Politecnica delle MarcheAnconaItaly
  13. 13.Neurological DepartmentAzienda Ospedaliera Università’ di PadovaPaduaItaly
  14. 14.Centro di Ricerca Interdipartimentale per la Sclerosi Multipla (CRISM), Istituto Neurologico Nazionale ‘C. Mondino’PaviaItaly
  15. 15.Clinica Neurologica, Fondazione Cà Granda Ospedale PoliclinicoMilanItaly
  16. 16.First Division of Neurology, Department of Clinical and Experimental Medicine and SurgerySecond University of NaplesNaplesItaly
  17. 17.II Clinica Neurologica, Dip.to di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell’InvecchiamentoSeconda Università di NapoliNaplesItaly
  18. 18.Unità Operativa di Neurologia Azienda Ospedaliero, Universitaria S. Anna FerraraFerraraItlay
  19. 19.Department of NeurosciencesUniversity of FlorenceFlorenceItaly
  20. 20.Dipartimento di Chirurgia del Sistema Nervoso e Neuroscienze, Multiple Sclerosis CenterOspedali Riuniti BergamoBergamoItaly

Personalised recommendations