Press Release of March 15, 2011
ISNVD Annual Meeting
ISNVD is the International Society for Neurovascular Disease,
at present highly committed to the study of CCSVI
Bologna, March 14 and 15, 2011
Many of the issues which are still open on the relationship between CCSVI and MS found an answer at the ISNVD (International Society for Neurovascular Disease) Annual Meeting. The Society, chaired by Prof. Paolo Zamboni, held its meeting in Bologna (Italy) on March 14-15, 2011 under the High Patronage of the President of the Italian Republic.
The Meeting – attended by registered physicians, researchers and accredited journalists – was preceded by a preliminary meeting of the International Scientific Committee on Sunday March 13. It was organized in the form of a Consensus Conference with the purpose of defining minimum starting points in the approach to the investigated diseases.
There was a great deal of interest in the research of CCSVI, the vascular condition discovered by Prof. Paolo Zamboni from the University of Ferrara, which seems to interfere with progression of Multiple Sclerosis.
The history of CCSVI recognition has indeed gone through a tortuous pathway, more so in Italy than in foreign countries. However, last Spring the Italian Higher Health Council assessed the “18-months’ results of a preliminary experience of correcting the stenosing lesions” as promising and regarded Prof. Zamboni’s observations as “being of undoubted interest and worth being further investigated with all the tools currently available to medical research”.
Highly distinguished world experts attended the Meeting in Italy, not only to confront themselves with the new scenarios opened up by this discovery, but also to discuss the independent studies successfully carried out by the most famous Universities in the world during the past two years.
The Meeting will be a milestone for CCSVI research: among the most significant presentations were those documenting the on-going experiences at the University of Stanford and UCSD, to mention just a few.
In particular, data were presented to show whether CCSVI is associated with MS (recent studies by several independent groups) and how CCSVI treatment with angioplasty may change and/or improve the MS symptoms as pointed out by recent studies performed with this type of treatment with the approval of the Ethics Committees of several Universities of the world.
The following were among of the main topics of discussion:
EPIDEMIOLOGY OF CCSVI IN MSMany different groups from all over the world clearly showed by the means of gold standard catheter venography that the prevalence of CCSVI in MS is more than 90% of the cases (USA, Greece, Poland, Jordan, ….).
To the contrary the prevalence of CCSVI in healthy people has been calculated in a study by using CT angiography in less than 8% of cases (Wayne state University, Michigan).
Prof. Bastianello present the data of an international epidemiology observatory that collected more than 700 cases with ECD carried out by trained staff. It is the first large multicenter study on CCSVI while those conducted so far were simply single-center studies.
The result of this non invasive study clearly confirm the data above because the percentage of MS patients with ccsvi is 86%.
ROLE OF OXYGENATION AND TISSUE DRAINAGE
Among the questions that were answered at the Meeting was also a fundamental one which relates to the observation made by Bruce Trapp from Cleveland (one of the most eminent MS researchers) according to whom nerve cell damage and death are due to an axonal asphyxial phenomenon which has not been yet completely clarified.
Data from a joint study conducted with perfusional MRI by the University of Buffalo, Prof. Zamboni and Dr Salvi (see relevant press release) - soon to be published in the BMC Medicine journal - were presented in Bologna by Prof. Robert Zivadinov, showing that this asphyxial cell phenomenon could be related to severe obstruction of the extracranial veins, thus providing a first substantial answer to asphyxial hypothesis in MS
ROLE OF IRON
Major contributions were presented on the role of iron, with particular reference to its build-up around the veins, which is one of the key points of the CCSVI theory.One of the pivotal observations is that iron builds up around the cerebral veins, even in the white matter. This is what mostly differentiates MS from many other inflammatory and neurodegenerative diseases.
The role of iron in nervous system degeneration was the subject of a dedicated session with a presentation by Prof. Iadecola from NY, one of the greatest experts in Alzheimer’s disease.
ADVANCED DIAGNOSTIC IMAGING
Over and above the well-established gold standard of catheter phlebography which was presented by Dr Roberto Galeotti, one of the pioneers in the use of this technique, all the new diagnostic tools developed for CCSVI during the past two years were reviewed during the opening session of the Meeting chaired by Profs. Haacke and Salvatore on Monday morning. The groups of Wayne State University, Detroit, and of the Buffalo Neuroimaging Analysis Center of the University of Buffalo presented a large amount of emerging data on advanced diagnostic techniques.
Concerning the screening methods – in which patients are mostly interested - new achievements have been proposed. From the diagnostic standpoint, one of the main objections is that diagnosis of CCSVI is being too dependent of Eco-Colour-Doppler and on the reading skills of the physician, therefore not always reproducible.
To avoid this, Prof. Zamboni and his team at the Center for Vascular Diseases of the Ferrara Hospital have developed a new diagnostic technique, i.e. cervical plethysmography. Data were presented how this non-invasive tool will allow for preliminary screening and diagnosis with high diagnostic reliability without being operator-dependent
.Cervical plethysmography is currently a prototype which is not yet commercially available but has some advantages: the test lasts only 5 minutes and makes it possible to obtain a final answer in 85% of cases.
However, this test does not rule out the need for ECD which must be performed if a subsequent patency procedure is to be carried out. Therefore, this new diagnostic method may become a fast and cheap screening procedure.
Concerning endovascular treatment, one can state that the highest level of scientific evidence is generated by double-blind randomized trials which require a long time for completion.In science it is well-known, however, that scientific evidence can also come from several observational studies which independently and scientifically measure the effects of a certain treatment in a very high number of patients.
Additional evidence was provided by the results of two American studies which were among the first to be carried out in this field. They are observational studies which measure the effects of angioplasty on a very large number of patients. They can be regarded as a corollary and driving element for other studies such as those which are about to be carried out in Italy.
The outcome of over 1,000 cases treated in different studies all over the world were presented. The most fascinating piece of research is the one of Dr D. Hubbard from the University of California San Diego.
Functional MRI is a real-time technique which makes it possible to identify the plastic changes that the brain undergoes during functional brain activities.
The cognitive skills of a group of 20 subjects with MS were measured by having them perform a series of memory and operational drills under functional MRI control.
After the necessary examinations, the San Diego team performed angioplasty on all 20 subjects with MS. When re-checked using functional MRI, they showed significant improvement in their cognitive skills which no longer differed from those of the healthy controls used for comparison. A second treatment study was presented by Dr M. Mehta from Albany Medical Center, NY, who studied 150 consecutive MS patients where he identified almost 300 jugular and azygos veins with significant stenosis and performed angioplasty.
In the post-operative phase, he monitored important aspects such as chronic fatigue which is one of the most disabling symptoms of MS and one with no therapeutic response.
Chronic fatigue improved significantly in all surgical patients. This was further confirmed by more than 25% increase in the quality of life scores as measured by physiatrists who were unaware of the surgical procedure one year after angioplasty.
Data are also available from the Polish Center of Katowice which alone operated on more than 1,000 patients, while Dr M. Zarebinski presented the data of 420 patients who underwent venoplasty in Warsaw.
This study confirmed the safety of the treatment, since in this and all other studies no complications or deaths were recorded. The study also confirmed significant improvement in chronic fatigue and quality of life.
Finally, Dr A. N. Siddiqui from Buffalo showed some preliminary data on a randomized trial which is currently being carried out on 30 patients at the Departments of Neurosurgery and Neurology of the University of Buffalo.
ANIMAL MODELSAs requested by many Scientific Committees throughout the world to legitimate research, the results of the development of animal models of CCSVI were presented by Stanford University, showing a correlation between reduced venous function and impaired motor ability
OTHER VASCULAR DISEASES THAT WERE DISCUSSED:
The Meeting was not limited to CCSVI but also covered important associations with other vascular diseases; for example, Costantino Iadecola spoke about Alzheimer’s disease and vascular dementia; many national and international experts talked about carotid artery treatment for stroke prevention; finally, Dr Fabrizio Salvi spoke about the unusual symptoms observed in his clinical practice in conjunction with cerebral venous diseases.
The vascular mechanisms involved in neurodegeneration were outlined in the keynote lecture of the Meeting which was delivered by a well-known neuroscientist, Prof. Berislav Zlokovic from Rochester NY.
Under the High Patronage of the President of the Italian Republic
Under the Patronage of:
Senate of the Italian Republic; Emilia Romagna Region; Province of Ferrara; City of Bologna; City of Ferrara; Alma Mater Studiorum - University of Bologna; University of Ferrara; Ordine Provinciale dei Medici Chirurghi e degli Odontoiatri di Bologna (Medical Association of the Province of Bologna); Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Ferrara (Medical Association of the Province of Ferrara); SICVE Italian Society of Vascular and Endovascular Surgery.
The Organizing Committee of the ISNVD Annual Meeting wishes to thank the following foundations, banks and companies for supporting the event: Fondazione Cassa di Risparmio in Bologna;
Platinum sponsor: ESAOTE;
Gold sponsor: Boston Scientific. Delivering what next and CARIFE, Gruppo Bancario Cassa di Risparmio di Ferrara;
Silver Sponsor: Flebysan and Volcano.
Special acknowledgement: Ducati
All the material disclosed at the Meeting is available on line on the following Website:www.isnvdannualmeeting.org