Position Statement: Interventional Endovascular Management..
Posted: Sat Oct 16, 2010 7:12 am
Position Statement: Interventional Endovascular Management of MS
http://www.sirweb.org/news/newsPDF/SIR_ ... t_JVIR.pdf
Don't know if this has been posted yet or not. I thought all the plumbers were on board:
http://www.sirweb.org/news/newsPDF/SIR_ ... t_JVIR.pdf
Don't know if this has been posted yet or not. I thought all the plumbers were on board:
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.