Dr. Lugli's study on ccsvi treatment using ivus

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Dr. Lugli's study on ccsvi treatment using ivus

Postby Cece » Sun Jun 10, 2012 3:25 pm

http://phleb.rsmjournals.com/content/27 ... 8.abstract
The hypothesis of patho-physiological correlation between chronic cerebrospinal venous insufficiency and multiple sclerosis: rationale of treatment

M Lugli⇓,
M Morelli,
S Guerzoni and
O Maleti

+ Author Affiliations

Department of Cardiothoracic and Vascular Surgery, Hesperia Hospital, Via Arquà, 80, 41100 Modena, Italy

Abstract

Background
The possible role of the venous system in the pathogenesis of chronic neurodegenerative diseases has been hypothesized for decades. Quite recently, the description of a venous condition defined as chronic cerebrospinal venous insufficiency (CCSVI) and its strong association with multiple sclerosis (MS) has brought back the attention of the scientific community to the hypothesis of an aetiological or concomitant role of an altered venous function in the occurrence of this pathology. CCSVI is identified by sonographic criteria, thus the indication for its possible treatment is based on ultrasound findings.

Method
We retrospectively examined 167 consecutive patients affected by clinically defined MS and CCSVI, identified by ultrasound assessment by the presence of at least two sonographic criteria. Ultrasonographic diagnosis of CCSVI was then integrated by venography and intravascular ultrasound examination (in 43 patients). Patients were all submitted to endovascular procedure (venoplasty).

Results
In 37% of cases there was no correspondence between the preoperative ultrasound assessment and the venographic findings. In the event of incongruity between venography and sonography, the intravascular ultrasound examination investigation, when performed, confirmed ultrasound findings in 42% of cases and venography results in 58%. At one month in 12% of cases ultrasound assessment showed the persistence of altered flux. In 67% of cases patients reported subjective amelioration, regarding non-specific symptoms.

Conclusion
The pathophysiology of CCSVI is yet to be defined. The superior cava venous system is highly complex in terms of anatomy and possible anomalies, as well as its haemodynamic mechanisms. Further studies are required to define the parameters of diagnosis and treatment of CCSVI.

Once again we hear that two-thirds of patients experience improvements ("subjective amelioration" of "non-specific" symptoms).
It would be good to know what separated the improvment group two-thirds from the no noticeable improvements one-third, and to know if that one-third might still experience a beneficial impact over time.

At one month, it was successful in 88% of patients but in 12% there was still "altered flux" meaning abnormal blood flow was still present.

And the comparison between venogram and sonography and ivus doesn't shed much light on which is best.

In 37% of case there was no correspondance between the preoperative doppler ultrasound and what was found on venogram?! That is a high percentage, and indicates that either the doppler technician needs more training or the doppler itself is a poor instrument for the important task of diagnosing CCSVI.
Cece
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Re: Dr. Lugli's study on ccsvi treatment using ivus

Postby 1eye » Sun Jun 10, 2012 6:43 pm

Cece wrote:http://phleb.rsmjournals.com/content/27/suppl_1/178.abstract
I have to assume a lot, since I don't have the paper.

Method:
They picked 167 pw"MS" with positive CCSVI according to Zamboni's criteria before the study. Looked at 43 of them with IVUS, and looked at results of venoplasty on all 167. It looks like they wanted to confirm the ultrasound results done previously.

Results:
Since 100% of the 167 were positive for CCSVI before the test, 37%, or 62 patients, were found to be negative for CCSVI by the study's venography. IVUS was not used in all the 62 CCSVI-negative patients; only 43 patients had IVUS.

It may have only been used where neither Doppler nor venography found CCSVI. Of the 43 that had IVUS, it did not agree with the ultrasound (found no CCSVI), in 42% (18 patients), and with the venography in 58%.

58% of 167 is 96 patients, so they could not have been talking about all 167 cases that had venogaphy.

58% of the 43 that had IVUS would have been an additional 25 patients found only to be CCSVI-negative by venography, and by neither of the other two tools. 58% + 42% covers all IVUS patients.

I agree that altered flux means reflux, still present (by Doppler) 1 month after venoplasty in 12% or 20 patients.

This seems to mean both IVUS and venography can find CCSVI when other tests can't.

Conclusions:
Again with the further studies.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Re: Dr. Lugli's study on ccsvi treatment using ivus

Postby Cece » Sun Jun 10, 2012 9:08 pm

Just once we should see a
Conclusions:
Every MS patient should be tested promptly for CCSVI, and treated if it is found.

I didn't realize that only 43 of the patients were looked at with IVUS.
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