David Hubbard, MD
Applied fMRI Institute, Hubbard Foundation, San Diego, California
Address correspondence to D.H., Applied fMRI Institute, Hubbard Foundation, 14168 Donart Dr, Poway, CA 92064
, Donald Ponec, MD, Justin Gooding, MD, Richard Saxon, MD, Heidi Sauder, PhD, Mark Haacke, PhD
Received 4 October 2011; received in revised form 7 July 2012; accepted 10 July 2012. published online 28 August 2012
This study proposed to prospectively evaluate safety and clinical changes in outpatient endovascular treatment in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI).
Materials and Methods
Two hundred fifty-nine patients with MS were followed with the Multiple Sclerosis Impact Scale (MSIS-29) before and for 1and 6 months after treatment of extracranial internal jugular vein and azygos vein stenoses and occlusions using venous angioplasty, as well as stent placement in 2.5% of patients. Before treatment, the patients were tested with magnetic resonance (MR) venography and flow quantification.
We found statistically significant improvements in the MSIS-29 scores (P < .01) at both 1 and 6 months. At 1 and 6 months, 67.9% and 53.6% were improved on the physical scale, respectively, and 53.0% and 44.4% were improved on the psychological scale, respectively. Women showed greater improvement than did men on the physical scale at 6 months (P = .01). Patients with primary progressive MS (PPMS) showed less improvement than did those with relapsing-remitting MS (RRMS) on the psychological scale at 1 month, and venoplasty treatment of more vein sites versus fewer vein sites showed greater improvement on the physical scale at both 1 and 6 months. Fifteen patients (6.3%) reported recurrent symptoms after clinical improvement and were treated again. There was one serious adverse event, a deep venous thrombosis at the catheter insertion site, which resolved with treatment.
Endovascular treatment of CCSVI in patients with MS appears to be a safe procedure resulting in significant clinical improvement.