This Is MS Multiple Sclerosis Knowledge & Support Community

3. At present, SIR considers the published literature to be inconclusive on whether CCSVI is a clinically important factor in the development and/or progression of MS, and on whether balloon angioplasty and/or stent placement are clinically effective in patients with
MS.
A compelling body of published research indicates that MS is a disorder
with predominantly autoimmune features and an unknown primary
etiology. The hypothesis that CCSVI may be a primary factor in the
pathogenesis of MS or an aggravating factor in its clinical progression, if
firmly established, would represent a major paradigm shift in the general
scientific understanding of this disorder.
The discovery of extracranial venous stenoses in patients with MS
certainly merits serious study, but it is unclear whether they truly represent a cause of MS versus a secondary effect of the pathologic process arising from the disease, an effect of MS treatments, or an unrelated finding.
Although promising, the pilot studies that suggest a clinical benefit
for patients with MS with the use of balloon angioplasty had important
methodologic limitations:
(i) small sample size (N 96 patients combined); (ii) single-center performance; (iii) lack of blinding of clinical outcome assessors; and (iv) nonrandomized design with lack of a placebo control group (particularly
limiting as a robust placebo effect would be expected in patients with MS)
(7,8). In addition, although balloon angioplasty and stent placement of
central thoracic veins have been performed safely for many years in
other clinical scenarios, the procedures are invasive and carry a risk of
complications. Also, the durability of clinical response has not been established.
Hence, the current body of literature is insufficient to judge (i)
whether an interventional treatment approach for MS is effective; if so, (ii)
for how long and (iii) whether its clinical benefits outweigh the associated
risks and costs; and (iv) which patients with MS, if any, should be
treated and at what stage in the disease process.

4. Interventional radiologists possess
the ideal skill set to provide
interventional MS therapy with
maximum safety and effectiveness
when clinically appropriate.If interventional MS therapy proves
to be effective, patients with MS must
be treated by physicians with specialized
expertise in delivering imageguided
venous treatments. Interventional
radiology is a recognized
subspecialty requiring dedicated training
that encompasses clinical patient
evaluation and management, noninvasive
venous imaging, catheter venography
and hemodynamic assessment,
and the delivery of targeted, imageguided,
minimally invasive treatments
to patients (15). Interventional radiologists
perform balloon angioplasty and
stent placements on a daily basis in
thousands of patients with diverse venous
conditions including acute deep
vein thrombosis, postthrombotic syndrome,
superior vena cava syndrome,
and portal hypertension; they also perform
procedures to maintain hemodialysis
access. SIR has a stated mission
to improve public health by pioneering
advances in image-guided
therapies. SIR and its members are
committed to developing and maintaining
the highest standards of excellence
in patient care, integrating disease
management, proficiency with a
wide range of imaging technologies,
and specialized technical expertise in
providing image-guided therapies. SIR
and its members adhere to the highest
standards of ethical behavior, placing
the interests of patients first.
5. SIR strongly supports the urgent
performance of high-quality clinical
research to determine the safety and
efficacy of interventional MS therapies,
and is actively working to promote
and expedite the completion
of the needed studies.SIR believes that the completion of
high-quality studies on CCSVI and
interventional MS therapies should
be considered an urgent research priority
by investigators, funding agencies,
and MS community advocates.
SIR, through its Neurovascular and
Venous Service Lines, is moving rapidly
to catalyze the development of
the needed studies by bringing together
expert researchers in imageguided
venous interventions, neurology,
central nervous system imaging,
MS outcomes assessment, and clinical
trial methodology.
CONCLUSION
SIR recognizes the challenge and
the potential opportunity presented
by promising early studies of an interventional
approach to the treatment of
MS. SIR is pleased that public advocacy
groups have pushed the medical
community forward to meet this challenge
and is committed to assuming a
national leadership role in launching
the needed efforts.

concerned wrote:On board for investigation maybe, who isn't, but I don't think that they recognize CCSVI as a causative, or even secondary factor to MS. The evidence just isn't there.

..A compelling body of published research..
..if firmly established, would represent a major paradigm shift...
..The discovery of extracranial venous stenoses in patients with MS
certainly merits serious study...
..it is unclear whether they truly represent a cause of MS versus a secondary effect of the pathologic process arising from the disease..
..promising..

When conclusive evidence
is lacking, SIR believes that these
often difficult decisions are best
made by individual patients, their
families, and their physicians.

concerned wrote:Yes, that certainly is true, and it should be an informed decision.

I've never said that people shouldn't be allowed to choose to have the procedure done, just that they should know that nothing is proven yet, and the safety profile of the procedure is largely unknown.

1eye wrote:The Final Arbiter of Information has Spoken. Careful where you look: you might find something someone doesn't want you to see.

concerned wrote:I've never said that people shouldn't be allowed to choose to have the procedure done, just that they should know that nothing is proven yet, and the safety profile of the procedure is largely unknown.

cheerleader wrote:http://www.thisisms.com/ftopic-13359-0- ... -sirs.html

a thread on both the Canadian and US society statements from August.
Good discussion--
cheer

drsclafani wrote:on Monday, a group has been convened by the Society of Interventional Radiology in Washington DC. We will discuss plans regarding establishing registries and defining a research agenda for CCSVI in North America.