May symptoms of chronic cerebrospinal venous insufficiency be improved by venous angioplasty? An independent 4-year follow up on 366 cases

Abstract

The aim of the study was to collect results from 366 chronic cerebrospinal venous insufficiency (CCSVI) affected patients that were regularly Duplex controlled after having received vein angioplasty following diagnosis for CCSVI. The procedures were all performed in the same Centre and same equipment. The patients were divided into three groups according to the attributed severity of the associated multiple sclerosis: 264 relapse-remitting (RR) (72%): 179 females (67.8%) and 85 (32.2%) males; 62 secondary progressive (17%): 37 (59.7%) females and 25 (40.3%) males; 40 primary progressive (11%): 22 (55%) females and 18 (45%) males. A data base revealed eleven most frequent disturbs and symptoms, together with working capacities, and was kept up-todate at every Duplex control aiming to establish a novel rapid CCSVI symptoms questionnaire assessment in 4 years follow up. The symptoms were: diplopia, fatigue, headache, upper limb numbness/mobility, lower limb numbness/mobility, thermic sensibility, bladder control, balance coordination, quality of sleep, vertigo, mind concentration. Results, as follows, appear to be significantly good in the RR group, also the biggest one. Diplopia improved in 262/264 patients (99.2%) (P<0.0001); fatigue in 260/264 (98.5%) (P<0.0001); headache in 205/208 (98.6%) (P<0.0001); balance coordination in 23/26 (88.5%) (P<0.0001); quality of sleep in 55/59 (93.2%) (P<0.0001); vertigo in 30/33 (90.9%) (P<0.0001); mind concentration in 142/144 (98.6%) (P<0.0001). Other results regarded: upper limb numbness and mobility in 20/24 (83.3%) (P=0.0002); lower limb numbness and mobility 13/15 (86.7%) (P=0.0087); thermic sensibility 3/4 (75%) [P: not significant (n.s.)]; bladder control 2/3 (66.6%) (P: n.s.). In contrast in the progressive cases results are quite different where, nevertheless, some useful considerations were collected and statistically significant, too. In addition, venous angioplasty appears to be safe, side effects were observed only in seven patients (0.19%) that grew a monolateral Jugular thrombosis but still were regularly controlled and above all did not suffer worsening of the disease. Finally, the overwhelming percutaneous transluminal angioplasty results in the RR group lead to say that the correct criteria should be <em>the sooner the better</em>.