Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis

Jagannath, Vanitha A; Pucci, Eugenio; Asokan, G V; Robak, Edward W

doi:10.1002/14651858.cd009903.pub3

Cited by 9 publications

(12 citation statements)

References 67 publications

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“…A recent Cochrane review based on the RCTs described above identified moderate-quality evidence that venous balloon angioplasty did not provide benefit in patients with MS regarding disability, physical or cognitive functions, relapse, and quality of life. 33 Finally, a recent RCT found significant improvement in several quality of life–related items in patients who underwent angioplasty. 34…”

Section: Discussionmentioning

confidence: 99%

Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial

Zamboni¹,

Galeotti

Salvi

et al. 2019

J Endovasc Ther

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Purpose: To evaluate if jugular vein flow restoration in various venographic defects indicative of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients can have positive effects on cerebral lesions identified using magnetic resonance imaging (MRI). Materials and Methods: The Brave Dreams trial ( ClinicalTrials.gov identifier NCT01371760) was a multicenter, randomized, parallel group, double-blind, sham-controlled trial to assess the efficacy of jugular venoplasty in MS patients with CCSVI. Between August 2012 and March 2016, 130 patients (mean age 39.9±10.6 years; 81 women) with relapsing/remitting (n=115) or secondary/progressive (n=15) MS were randomized 2:1 to venography plus angioplasty (n=86) or venography (sham; n=44). Patients and study personnel (except the interventionist) were masked to treatment assignment. MRI data acquired at 6 and 12 months after randomization were compared to the preoperative scan for new and/or >30% enlargement of T2 lesions plus new gadolinium enhancement of pre-existing lesions. The relative risks (RR) with 95% confidence interval (CI) were estimated and compared. In a post hoc assessment, venograms of patients who underwent venous angioplasty were graded as “favorable” (n=38) or “unfavorable” (n=30) for dilation according to the Giaquinta grading system by 4 investigators blinded to outcomes. These subgroups were also compared. Results: Of the 130 patients enrolled, 125 (96%) completed the 12-month MRI follow-up. Analysis showed that the likelihood of being free of new cerebral lesions at 1 year was significantly higher after venoplasty compared to the sham group (RR 1.42, 95% CI 1.00 to 2.01, p=0.032). Patients with favorable venograms had a significantly higher probability of being free of new cerebral lesions than patients with unfavorable venograms (RR 1.82, 95% CI 1.17 to 2.83, p=0.005) or patients in the sham arm (RR 1.66, 95% CI 1.16 to 2.37, p=0.005). Conclusion: Expanded analysis of the Brave Dreams data that included secondary/progressive MS patients in addition to the relapsing/remitting patients analyzed previously showed that venoplasty decreases new cerebral lesions at 1 year. Post hoc analysis confirmed the efficacy of the Giaquinta grading system in selecting patients appropriate for venoplasty who were more likely to be free from accumulation of new cerebral lesions at MRI.

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Section: Discussionmentioning

confidence: 99%

Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial

Zamboni¹,

Galeotti

Salvi

et al. 2019

J Endovasc Ther

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“…Our literature search also yielded data suggesting that balloon angioplasty may be useful in the treatment of autonomic dysfunction [61]. However, it must be considered that the concept of chronic cerebrospinal venous insufficiency has been disproved in the meantime and this intervention cannot be recommended according to the current state of knowledge [120].…”

Section: Discussionmentioning

confidence: 89%

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Findling

Hauer

Pezawas

et al. 2020

JCM

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Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case-control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing-remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression.

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“…Previous literature on stenting has been controversial for the efficacy of IJVS Caucasians with multiple sclerosis (16)(17)(18)(19)(20)(21). In our previous cohort study, we found that nonexternal-compressed IJVS Chinese in the absence of multiple sclerosis was significantly able to benefit from stenting (22).…”

Section: B Amentioning

confidence: 75%

Clinical characteristics and neuroimaging findings in eagle syndrome induced internal jugular vein stenosis

Bai¹,

Wang²,

Guan³

et al. 2020

Ann Transl Med

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Background: Eagle syndrome is a condition that causes pharyngeal pain, facial pain, swallowing difficulties, and symptoms of arterial impingement due to the elongated styloid process. However, few reports were about eagle syndrome with venous compression up to now. This study aimed to identify the clinical profiles of the internal jugular vein stenosis (IJVS) related eagle syndrome comprehensively.Methods: A total of 27 patients, who were diagnosed as IJVS induced by styloid process compression were enrolled. The clinical manifestations and imaging features were analyzed.Results: Styloid process compression was presented in all of the 27 IJVS patients, in which, the top three symptoms included insomnia (81.5%), tinnitus (63.0%) and head noises (63.0%). The most vulnerable segment of internal jugular vein (IJV) was J3 segment (96.3%). The average styloid process length in our study was 3.7 cm. Hearing impairment was more common in bilateral IJVS (68.8% vs. 18.2%, P=0.018). One patient reported significant relief of symptoms at 1 year follow-up after underwent styloidectomy combined with stenting.Conclusions: Neurological symptoms of eagle syndrome induced IJVS were various, including either arterial or venous issues. Better understanding of this disease entity may be helpful for clinical diagnosis and treatment.

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Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis

Abstract: Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insu iciency (CCSVI) in people with multiple sclerosis.

Cited by 9 publications

References 67 publications

Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial

Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Clinical characteristics and neuroimaging findings in eagle syndrome induced internal jugular vein stenosis

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