Abstract No. 382: Feasibility evaluation of catheter-directed interventions in multiple sclerosis CCSVI patients

Abstract

To report the feasibility results of balloon angioplasty and stent placement for treatment of multiple sclerosis related CCSVI symptoms. 18 consecutive patients (5M, 13F), mean age 48 yrs (r, 35–64) with relapsing remitting (n=10), secondary progressive (n=5), post-progressive (n=1), primary progressive (n=2), unknown (n=1) underwent 19 single-operator procedures. Standardized intervention protocol included IVUS, left and right internal jugular (LIJV, RIJV), azygous venograms in 3-head positions, imaging intensifier angulations, quiet breathing, no sedation. 3-month follow-up; clopidogrel for stents, ASA for PTA. There were 18/19 RIJV and 19/19 LIJV valvular flow restrictions were treated with 10–16mm PTA (most common 14mm RIJV, 12mm LIJV). Mid RIJV (n=2), LIJV (n=5); high LIJV (n=2); and azygous arch stenoses (13/19) with 6–8 mm PTA. 10 tapered and non tapered nitinol stents in 9/19 cases: n=2 azygous, LIJV (n=5, 2mid, 1 upper, 2 valve/lower), RIJV (3 mid/lower overlap). IVUS improved confirmation of MRV stenoses in all cases. % valve stenoses could not be quantified due to dynamic function. Patient self-reported outcomes by interview and MS-QOL: uniformly positive, heterogeneous change except index case. Examples: improved motor function (eg stair climb, foot drop, ability to drive, abandoned of assistive devices, swallowing, breathing effort); sensory (eg resolved/reduced numbness in extremities, better balance); fatigue (reduction), cognitive (reduced/nearly vanished impairment), visual (clarity and color); temperature sensitivity (coldness and heat tolerance). Direct physician clinic observation confirms self-reported motor and balance change. Complications included 1 resolved allergy to clopidogrel; 1 contained LIJV valve rupture, resolved with balloon tamponade, and bare stent. Catheter directed interventions in MS CCSVI patients can be safely accomplished. Feasibility results confirm strong positive early self reported improvements, some confirmed by direct observation. Conventional thresholds for intervention are not initially predictive, suggesting new scales will need development.