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Describe our experience in the management of CCSVI in patients with multiple sclerosis (MS).
Materials and Methods
This is an IRB approved retrospective review of 105 procedures performed in 94 patients (35 men/59 women) with MS between 06/2010 and 09/2011. Mean age was 47.8 years (26-67). All patients had MS by Mc Donald criteria. Clincal categories were: 50% (47/94) Relapsing remitting (RR); 34% (32/94) Secondary Progressive (SP); 6.3% (6/94) Primary Progressive (PP) and 6.3% (6/94) unknown. Procedures were performed under conscious sedation. Jugular (JV) and azygos (AV) veins were evaluated with selective venography and intravascular ultrasound (IVUS). Angioplasty was performed if venograms or IVUS confirmed greater than 50% decrease in luminal diameter or reflux. Stents were used to treat non-responsive lesions or occlusions. Patients were anti-coagulated for 10 days and Plavix was given for 6 weeks. Follow-up included JV ultrasound (US) one week post-procedure and clinic visits with MSIS scores every three months. Results are presented as percentages.
Venography and IVUS showed stenosis in 94.9% (89/94) of patients and were normal in 5.2% (5/94). Venous stenoses were seen in a total of 179 veins: both JV (n=28) [31.5%], both JV and AV (n=21) [23.6%]; one JV and AV (n=20) [22.47%]; one JV (n=15) [16.85%] and AV (n=5) [5.61%]. Angioplasty was performed in all abnormal veins. Stents were placed in 5/179 (2.8%) veins. Indications for stent were: azygos vein kink (n=3) and JV occlusion (n=2). Symptomatic improvement was reported by 48/89 (53.9%) patients; questionable improvement: 15/89 (16.85%) and no improvement: 26/89 (29.2%). Improvement was highest in RR patients [28/47] (59.6%). Indications for repeat intervention were: JV thrombosis 3/89 (3.4%), restenosis on follow-up US 3/89 (3.4%) and recurrent symptoms 3/89 (3.4%). Complications included: JV thrombosis 3/89 (3.4%) and bleeding at puncture site in 3/89 (3.4%). One patient died 4 months after the procedure of an unknown cause.
Our results confirm that venous abnormalities are common in patients with MS. Angioplasty is safe in these patients and provided symptomatic benefit in 54% of our patients.