This must have been discussed here but I can't find it.
This is a case of pediatric MS, diagnosed at age 13, treated for CCSVI at age 23. The patient had previously had angioplasty twice, first to the left jugular and then to both jugulars. This time around, the doctors could find no stenoses within the vein, but found two areas of extrinsic compresion.
No intraluminal IJV stenoses were found, but ARSA was verified with a head compression to trachea and esophagus and secondary brachiocephalic vein obstruction. (Fig. 1) Bilateral IJV distal obstruction by first cervical vertebra transverse process was found as well.
I'm not familiar with ARSA so I'd better keep reading.
The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA), which can be seen in 0.5% to 1.8% of the population.1,2 ARSA can indent the esophagus and the trachea posteriorly, which clinically presents as dysphagia lusoria and airway narrowing.
In this case the aberrant right subclavian artery was compressing the innominate vein.
The doctors chose to not treat. I think they could have stented the innominate vein in the area of the compression. They mention surgical decompression as a possible treatment option but state that it is unclear whether that would alleviate neurological symptoms.
The paper draws attention to the innominate vein as among the veins that can be involved in CCSVI.
The patient's MS manifested very early, at age 13. Could this be because the CCSVI was particularly severe?