OBJECTIVES:Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). The objective of the study was to see if percutaneous transluminal angioplasty (PTA) of duplex-detected lesions, of the internal jugular and/or azygous veins, was safe, burdened by a significant restenosis rate, and whether there was any evidence that treatment reduced MS disease activity. DESIGN: This was a case-control study. MATERIALS: We studied 15 patients with relapsing-remitting MS and duplex-detected CCSVI. METHODS:Eight patients had PTA in addition to medical therapy (immediate treatment group (ITG)), whereas seven had treatment withPTA after 6 months of medical therapy alone (delayed treatment group (DTG)). RESULTS: No adverse events occurred. At 1 year, there was a restenosis rate of 27%. Overall, PTA was followed by a significant improvement in functional score compared with baseline (p < 0.02). The annualised relapse rate was 0.12% in the ITG compared with 0.66% in the DTG (p = NS). Magnetic resonance imaging (MRI) blindly demonstrates a trend for fewer T2 lesions in the ITG (p = 0.081), corresponding to a 10% decrease in the ITG compared with a 23% increase in the DTG over the first 6 months of the study. CONCLUSIONS: This study further confirms the safety of PTA treatment in patients with CCSVI associated with MS. The results, despite the significant rate of restenosis, are encouraging and warrant a larger multicentre double-blinded, randomised study.
RCT Entities:
OBJECTIVES:Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). The objective of the study was to see if percutaneous transluminal angioplasty (PTA) of duplex-detected lesions, of the internal jugular and/or azygous veins, was safe, burdened by a significant restenosis rate, and whether there was any evidence that treatment reduced MS disease activity. DESIGN: This was a case-control study. MATERIALS: We studied 15 patients with relapsing-remitting MS and duplex-detected CCSVI. METHODS: Eight patients had PTA in addition to medical therapy (immediate treatment group (ITG)), whereas seven had treatment with PTA after 6 months of medical therapy alone (delayed treatment group (DTG)). RESULTS: No adverse events occurred. At 1 year, there was a restenosis rate of 27%. Overall, PTA was followed by a significant improvement in functional score compared with baseline (p < 0.02). The annualised relapse rate was 0.12% in the ITG compared with 0.66% in the DTG (p = NS). Magnetic resonance imaging (MRI) blindly demonstrates a trend for fewer T2 lesions in the ITG (p = 0.081), corresponding to a 10% decrease in the ITG compared with a 23% increase in the DTG over the first 6 months of the study. CONCLUSIONS: This study further confirms the safety of PTA treatment in patients with CCSVI associated with MS. The results, despite the significant rate of restenosis, are encouraging and warrant a larger multicentre double-blinded, randomised study.
Authors: A Ghezzi; P Annovazzi; E Cocco; G Coarelli; A Lugaresi; M Rovaris; F Patti; E Capello; M E Rodegher; L Moiola; S Malucchi; G Salemi; N De Rossi; L Provinciali; P Perini; R Bergamaschi; E Scarpini; G Lus; A Gallo; M R Tola; M P Amato; M R Rottoli; A Bianchi; G Comi Journal: Neurol Sci Date: 2013-01-25 Impact factor: 3.307
Authors: Adnan H Siddiqui; Robert Zivadinov; Ralph H B Benedict; Yuval Karmon; Jihnhee Yu; Mary L Hartney; Karen L Marr; Vesela Valnarov; Cheryl L Kennedy; Murali Ramanathan; Deepa P Ramasamy; Kresimir Dolic; David W Hojnacki; Ellen Carl; Elad I Levy; L Nelson Hopkins; Bianca Weinstock-Guttman Journal: Neurology Date: 2014-06-27 Impact factor: 9.910