Dr. S., how convinced are you that CCSVI is congenital? One recent study suggests it is caused by chronic MS and not present at all in most early MS cases. http://www.ncbi.nlm.nih.gov/pubmed/21041329
I read that paper with interest. It is a very interesting paper that warrants study and analysis.
The authors performed venography on 42 patients looking for stenoses. They had two groups, an early group and a late MS group. The early group was comprised of 18 RRMS of less than five years of duration and 11 patients with clinically isolated syndrome. The late group was comprised of patient with RRMS of more than te3n years duration. SPMS and PPMS were excluded.
The authors required that three criteria be met:
1. stenosis were greater than 50%. the authors did not document whether this was cross-sectional area or diameter measurements.
2. delayed clearance of the contrast media
3. absence of valve leaflets.
Collateral veins were not considered.
They found that 19 of 42 patients had a vascular stenosis. Most had only one vein stenotic. Not surprisingly only one of 11 patients with CIS had a stenosis. Moreover, stenosis was more prevalent in the group that had MS greater than ten years.
So while almost 50% of their patients had stenosis, the stenosis only involved one vessel in most of these patients.
The authors concluded that because early MS was not associated with as much stenosis as lfor patients who had had the MS for ten years or more, this was not likely to be a congenital problem but one that was acquired.
I was surprised by this information. i do not have sufficient patients in each group to make such an analysis at this point. So i cannot corrorboarate or refute their assessments.
I thought there were several deficiencies of the study
1. they only used 50 cc of contrast for all these angiograms. This seems liike much less than i would have expected. They did at least 8 injections, meaning that each angiogram would only have six cc of contrast media. That is not very much contrast
2. i do not know why they required three criteria to be met to have a stenosis
3. they do not mention whether they calculate the stenosis as a percentage of diameter reduction or cross sectional area reduction. This is very important 4. they excluded valve prominence as a finding of stenosis. I believe this is a valve disease, so this is at cross currents with my observations. I have done several manuevers that document that these prominent valves do not open properly. For example IVUS is quite clear. Also dilatation of these areas shows a pronounced "waist" on the balloon at the oint of obstruction.
5. i thought that some of the cases that they showed not having stenoses actually had stenoses.
So, i consider the paper food for thought, but that it could not make such conclusions. I am concerned about how these patients were evaluated.
nonetheless, while it is certainly not a strong endorsement, this paper does show association between MS and venous stenosis.
I think we need to keep in mind, that we are not treating MS, we are treating CCSVI and our goals are improvement in quality of life.