Abstract No. 3: Safety of outpatient endovascular treatment of the internal jugular and azygos veins for chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis: A retrospective analysis

Article Outline

• Purpose
• Material and Methods
• Results
• Conclusion
• Copyright

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Purpose 

To evaluate the safety of outpatient endovascular treatment of the internal jugular and azygos veins in MS patients with CCSVI.

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Material and Methods 

A retrospective analysis of MS patients with CCSVI undergoing endovascular treatment of the internal jugular and/or azygos veins was performed to identify and describe the adverse events occurring within 30 days.

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Results 

Over 7 months, 247 procedures were performed in 231 patients. The mean patient age was 48.2 years (range: 25.7–70.2 years); 63.7% were female and 36.3% were male. 49.0% (121/247) of the procedures were performed in a hospital and 51.0% (126/247) were performed in the office setting. 92.7% (229/247) were primary procedures while 7.3% (18/247) were secondary due to restenosis. For patients treated primarily, 86.5% (198/229) underwent angioplasty and 11.4% (26/229) underwent stent placement of at least one vessel; the remaining 5 patients were not treated. For patients treated due to restenosis, 50% (9/18) underwent angioplasty and 50% (9/18) underwent stent placement. After 99.2% (245/247) of the procedures, patients were discharged within 3 hours. A post-procedure, transient headache was reported in 8.5% (21/247); this persisted beyond 30 days in 1 patient. Neck pain was reported in 15.8% of patients (39/247); 53.8% (21/39) of these patients underwent stent placement. 1.7% (4/231) of patients were retreated within 30 days due to symptomatic restenosis. Sustained cardiac arrhythmias were observed in 3 patients during the procedure with 2/3 patients requiring hospital admission. One of these patients, who underwent a complex procedure for in-stent thrombosis, required a prolonged hospitalization due to a stress-induced cardiomyopathy.

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Conclusion 

Endovascular treatment of CCSVI in MS patients is a safe procedure when performed on an outpatient basis. Cardiac monitoring is essential to permit detection and rapid treatment of patients with procedure-induced arrhythmias. Post-procedure ultrasound is recommended to detect venous thrombosis. In addition, consideration should be given to performing complex re-interventions in a hospital given the complication risk in this sub-population of patients.