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Percutaneous Endovascular Procedure Proven Safe and Tolerable in Patients With MS: Presented at ECTRIMS

Posted Oct 18 2010 12:00am
By David S. MacDougall   - DG Dispatch's DOCGUIDE

GOTHENBURG, Sweden -- October 17, 2010 -- A minimally invasive endovascular treatment for chronic cerebrospinal venous insufficiency (CCSVI) has proven safe and well tolerated in a small group of patients with multiple sclerosis (MS), according to a report presented here at the 26th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).

CCSVI is a condition characterised by multiple strictures at the level of the main extracranial cerebrospinal venous outflow tracts that may interfere with normal venous drainage. CCSVI has been implicated in the pathophysiology of MS, but the association remains unproven and controversial.

A group of 15 patients with MS were enrolled in a longitudinal pilot study of endovascular treatments described here on October 14 by Paolo Zamboni, MD, Vascular Diseases Center, University of Ferrara, Ferrara, Italy.

All subjects had CCSVI as previously determined by magnetic resonance imaging (MRI) studies, and were treated with standard disease-modifying MS therapies. Half of the patients received immediate endovascular treatment and the other half received delayed endovascular treatment 6 months after study enrolment.

Endovascular treatment consisted of selective venography of the cerebrospinal vasculature complemented by percutaneous balloon dilatation when indicated. All patients were prospectively evaluated with sonography, MRI, and clinical examinations for up to 12 months following endovascular treatment.

No serious adverse events were observed during the study. One patient developed a transitory vasovagal syndrome about 1 hour after endovascular treatment.

Restenosis occurred in 29% of the patients (2 in the immediate endovascular-treatment group and 2 in the delayed endovascular-treatment group) between 3 and 12 months after endovascular treatment. No significant worsening of MRI or clinical features was observed in either group following endovascular treatment.

The T2 lesion number decreased significantly in the delayed endovascular-treatment group during the time between initial study enrolment and the 6-month follow-up after endovascular treatment (P =.0227).

Additional and larger studies are needed to determine the potential role of endovascular treatment in the treatment of patients with MS, Dr. Zamboni concluded.

Funding for this study was provided by Hilarescere Foundation.

[Presentation title: Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis. A Longitudinal Pilot Study. Abstract P508] 



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