After three months many patients (about 50%) demonstrated a US restenosis with loss of benefits.
auth: Regine R.,Giurbino M., De Siero M., De Sio A., Ragozzino A. presauth: Regine Renato
institutions: Vascular Radioogy, Rad.Dep., ICU Dep.
CCSVI--angioplastic treatment: our protocol and preliminary results presentation
abstract: There is a correlation between MS and chronic cerebrospinal venous insufficiency (CCSVI), a hemodynamic syndrome characterized by cerebrospinal venous drainage anomalies Stenosis of the internal jugular (IJVs) and vertebral veins, of azygous (AZY) venous system and/or of lumbar veins, cause slowed and long-lasting reflux flow, associated with the opening of vicarious collateral veins ; an increased mean cerebral transit time, raised venous pressure can stretch vein walls sufficiently to separate the tight junctions between endothelial cells forming the blood–brain barrier.
We studied CCVSI in MS patients, by means of color-Doppler-US examination and venography. We report our experience with angioplastic treatment of IJVs and AZY stenosis in patients with CCSVI syndrome.
We treated patients with CCSVI US diagnosed using Zamboni criteria for suspicious abnormal extracranial cerebral venous outflow. A relative expanded disability disease score (EDSS) and a value of fatigue severity score (FSS) before the treatment; we performed venography of azygous and internal jugular via the transfemoral route to evaluate the degrees of stenosis, the valvular hypertrophy and the entity of reflux. We can measure the pressure in SVC, IJV and AZY before and after angioplastic treatment.
We investigated 135 patients (75 F and 55 M with the age range between 22 and 73 years old) with MS defined. We considered a significant stenosis to be any venous lumen reduction greater than 50%. Others pathologic signs were: hypoplasia, valvular hypertrophy, and reflux. In addition, selective venography allowed us to measure with a manometer the pressure expressed in cm/H2O in the SVC, in the AZY vein, and in both the IJVs.
Patients with stenotic veins underwent balloon angioplasty. No mayor complications were registered. The follow up (at 1 and 3 months) demonstrated after the treatment a lower EDSS score (by 20% at one month and 23% at three months) and improvement of the Fatigue Severity Score test (by 65% at one month and 76% at three months. ) After three months many patients (about 50%) demonstrated a US restenosis with loss of benefits.
We can measure the pressure in SVC, IJV and AZY before and after angioplastic treatment.
No mayor complications were registered.
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