Role of Venoplasty for Treatment of Multiple Sclerosis: Value of Open-label Studies and Surrogate Treatment Outcomes

Abstract

Multiple sclerosis (MS) is considered an autoimmune disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration ( 1 Frohman E.M. Racke M.K. Raine C.S. Multiple sclerosis--the plaque and its pathogenesis. N Engl J Med. 2006; 354: 942-955 Crossref PubMed Scopus (1346) Google Scholar ). The underlying cause of MS is still unknown. The concept of a vascular link to the etiology of MS was pursued from the early years of initial MS descriptions ( 2 Charcot J. Histologie de la sclerose en plaques. Gaz Hopit Civils Milit. 1868; 41: 554-566 Google Scholar , 3 Putnam T. The pathogenesis of multiple sclerosis, a possible vascular factor. N Engl J Med. 1933; 209: 786-790 Crossref Google Scholar ). Recently, the venous vascular hypothesis returned to the forefront of MS research following a report that chronic cerebrospinal venous insufficiency (CCSVI) is unique to patients with MS ( 4 Zamboni P. Galeotti R. Menegatti E. et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009; 80: 392-399 Crossref PubMed Scopus (577) Google Scholar ). CCSVI is a vascular condition defined as impaired blood outflow from the central nervous system to the periphery, secondary to anatomic and functional abnormalities of the major extracranial veins ( 4 Zamboni P. Galeotti R. Menegatti E. et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009; 80: 392-399 Crossref PubMed Scopus (577) Google Scholar , 5 Zamboni P. Galeotti R. Menegatti E. et al. A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg. 2009; 50 (e1–e3): 1348-1358 Abstract Full Text Full Text PDF PubMed Scopus (329) Google Scholar , 6 Zivadinov R. Marr K. Cutter G. et al. Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS. Neurology. 2011; 77: 138-144 Crossref PubMed Scopus (184) Google Scholar , 7 Dolic K. Marr K. Valnarov V. et al. Intra- and extraluminal structural and functional venous anomalies in multiple sclerosis, as evidenced by 2 noninvasive imaging techniques. AJNR Am J Neuroradiol. 2012; 33: 16-23 Crossref PubMed Scopus (32) Google Scholar , 8 Bastianello S. Romani A. Viselner G. et al. Chronic cerebrospinal venous insufficiency in multiple sclerosis: clinical correlates from a multicentre study. BMC Neurol. 2011; 11: 132 Crossref PubMed Scopus (38) Google Scholar , 9 Ludyga T. Kazibudzki M. Simka M. et al. Endovascular treatment for chronic cerebrospinal venous insufficiency: is the procedure safe?. Phlebology. 2010; 25: 286-295 Crossref PubMed Scopus (79) Google Scholar , 10 Mandato K.D. Hegener P.F. Siskin G.P. et al. Safety of endovascular treatment of chronic cerebrospinal venous insufficiency: a report of 240 patients with multiple sclerosis. J Vasc Interv Radiol. 2012; 23: 55-59 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar ). However, recent studies have demonstrated that venous-related abnormalities are not exclusive to patients with MS, and that healthy individuals or patients with other neurologic diseases can also present with these anomalies ( 6 Zivadinov R. Marr K. Cutter G. et al. Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS. Neurology. 2011; 77: 138-144 Crossref PubMed Scopus (184) Google Scholar , 7 Dolic K. Marr K. Valnarov V. et al. Intra- and extraluminal structural and functional venous anomalies in multiple sclerosis, as evidenced by 2 noninvasive imaging techniques. AJNR Am J Neuroradiol. 2012; 33: 16-23 Crossref PubMed Scopus (32) Google Scholar , 11 Wattjes M.P. van Oosten B.W. de Graaf W.L. et al. No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow-quantification study. J Neurol Neurosurg Psychiatry. 2011; 82: 429-435 Crossref PubMed Scopus (121) Google Scholar , 12 Centonze D. Floris R. Stefanini M. et al. Proposed chronic cerebrospinal venous insufficiency criteria do not predict multiple sclerosis risk or severity. Ann Neurol. 2011; 70: 51-58 Crossref PubMed Scopus (86) Google Scholar ). Likewise, the clinical correlates of these findings are still unknown. Clinical Improvement after Extracranial Venoplasty in Multiple SclerosisJournal of Vascular and Interventional RadiologyVol. 23Issue 10PreviewThis study proposed to prospectively evaluate safety and clinical changes in outpatient endovascular treatment in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI). Full-Text PDF