Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency
Imperial College CCSVI Investigation Group:, A Thapar *, T R A Lane * , V Pandey *, J Shalhoub *, O Malik , M Ellis *, I J Franklin * , R Nicholas * and A H Davies *
* Imperial College London; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units.
It sounds like the thrombosis was treatable ('requiring open thrombectomy for symptom relief').
We need the full paper -- what is meant by fully anticoagulated, was it a true anticoagulant? Was it a valvuloplasty procedure as the majority of CCSVI cases are? Were the balloons appropriately sized?
I agree with the part highlighted. We've seen it happen. This fits with Dr. Cumming's statement when he first showed up at TIMS of being aggressive enough to get the job done but not too aggressive to injure the vein (paraphrased) and Dr. Sclafani's recent discussion of finding the right mix of being bold and gentle on the veins.
Thanks, dania, this was a good find.