Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by
anomalies of the primary veins outside the skull that has been reported to be associated with
MS. In the blinded Combined Transcranial (TCD) and Extracranial Venous Doppler
Evaluation (CTEVD) study, we found that prevalence of CCSVI was significantly higher in
multiple sclerosis (MS) vs. healthy controls (HC) (56.1% vs. 22.7%, p < 0.001).
The objective was to evaluate the clinical correlates of venous anomalies indicative of
CCSVI in patients with MS
The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other
neurological disorders who underwent a clinical examination and a combined Doppler and
TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RRMS:
n = 181, SP-MS: n = 80 and PP-MS: n = 12). Disability status was evaluated by using the
Kurtzke Expanded Disability Status Scale (EDSS) and MS severity scale (MSSS).
Disability was not associated with the presence (≥2 venous hemodynamic criteria) or the
severity of CCSVI, as measured with venous hemodynamic insufficiency severity score
(VHISS). However, the severity of CCSVI was associated with the increased brainstem
functional EDSS sub-score (p = 0.002). In logistic regression analysis, progressive MS (SPMS
or PP-MS) vs. non-progressive status (including RR-MS) was associated with CCSVI
diagnosis (p = 0.004, OR = 2.34, CI = 1.3–4.2).
The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has
no or very limited association with clinical disability.
The problem that I see is that if doppler is not the gold standard, it may be meaningless to make comparisons between patients found to have CCSVI by doppler and the patients not found to have CCSVI. We have the abstract from Siskin's team stating that the patients who had negative ultrasounds generally had positive findings when the catheter venogram was done. The finding by BNAC that 56% of patients with MS have CCSVI is out of line with what's being seen clinically.