CCSVI ten years later
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Two very recent scientific papers have re-opened a debate on a vascular issue, chronic cerebrospinal venous insufficiency (CCSVI), that apparently was sent in a corner by other trials and some Editorial hasty conclusions. The never-ending debate is still open and, perhaps, a one-year truce helped to calm waters and sort out, as by means of a sandbox, the situation from the vascular point of view. Before discussing why these recent papers have widened the path for CCSVI, some mind refreshing is mandatory, since the opinions are spread in all directions and a concise summary may help for those that are newcomers in this issue.
Venous disease is present in every medicine textbook and always regarded a pathological vein condition for the lower limbs. Hemorheological remedies, both medical and surgical, have so far principally aimed to relieve symptoms and correct hemodynamic aspects, improving quality of life and slowing a process that apparently cannot be stopped. The term
chronic itself means that the disease cannot be completely removed and this condition should always be remembered.
Ten years ago Paolo Zamboni opened the fossilized gaze from the lower limbs to the brain and reminded us that there is a
venous return system in this district too. Like for the lower limbs, a cerebral venous return misfunction can give consequences and, coincidentally, this situation is most present in some progressive neurological diseases. At that time the attention was focalized on one specific category of disease: multiple sclerosis (MS).
... promptly labeled ineffective with the omission that more than 50% of the treated popula ion indeed had received benefits, without this being the principal aim of the Trial.
.. the patterns of the progressive subgroup were analyzed separately from the relapsing-remitting one, ... We can comment further observations that come from two new published Studies.
The first from the Journal of Endovascular Therapy, where Dr Zamboni and Colleagues report a reanalysis of all patients enrolled in the Brave Dreams, but this time also including secondary/progressive MS patients.
...demonstrated how vein angioplasty had a significant effect upon the diseases’ activity, quantified by freedom imaging of new cerebral lesion development on MRI and/or decreased activity of existing lesions at 12 months in a population that included SP MS patients in addition to the RR group.
... it proves the equivalence between re-established drainage flow and the absence of formation of new plaques, which
is the anatomy-pathological essence.