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rates of relapse- free patients passed from 27% to 50% postoperatively

Objective: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular picture characterized by combined stenosies of the principal pathways of extracranial venous drainage, including the internal jugular veins (IJVs), and the azygous vein (AZY), with development of collateral circles and insufficient drainage proved by increased mean transit time in cerebral MRI perfusional study. CCSVI is strongly associated with multiple sclerosis (MS), a neurodegenerative disease considered autoimmune in nature. Aim of this study is to evaluate the safety of CCSVI endovascular treatment and the influence on the clinical outcome of the associated MS. Methods: Sixty-five (65) consecutive patients affected by CCSVI subdivided by clinical course of MS into 35 with relapsing remitting (RR), 20 with secondary progressive (SP), and 10 with primary progressive (PP), underwent percutaneous transluminal angioplasty (PTA). Mean follow-up lasted 18 months. Vascular outcome measures: postoperative complications, venous pressure, patency rate. Neurological outcome measures: cognitive and motor function assessment (MSFC), rate of MS relapse, rate of MRI active positive enhanced gadolinium MS lesions (Gad+), QoL MS questionnaire. Results: Endovascular treatment of CCSVI was feasible in Day Surgery with a minor and negligible complication rate. Postoperative venous pressure was significantly lower in the IJVs, and in the AZY as well (p<0.001). The risk of restenosis in the IJVs was higher as compared to the AZY (IJVs patency rate 53%, AZY patency rate 96%, respectively: OR 16, 95% CI 3.5-72.5 p<0.0001). Clinical outcome measures of MS were significantly improved by CCSVI endovascular treatment, especially in the RR group: rates of relapse- free patients passed from 27% to 50% postoperatively (p<0.001), and that of MRI Gad+ lesions from 50% to 12% (p<0.0001); MSFC at one year improved significantly in RR (p<0.008), but not in PP or SP; finally, physical QoL improved significantly in RR (p<0.01) and in PP patients (p<0.03), with a positive trend in SP (p<0.0 . Mental QoL showed significant improvement in RR (p<0.003) and in PP (p<0.0 1), but in SP did not. Conclusions: PTA of venous strictures in CCSVI patients is safe, and especially in patients with RR clinical course demonstrated to positively influence clinical and QoL parameters of the associated MS respect to preoperative assessment. Restenosis rates are elevated in the IJVs but very promising in the AZY, suggesting the need to improve endovascular techniques in the former. The result of this pilot study warrants a subsequent randomized control study.