Vascular Web Logo

SVS  SVS Foundation
A A A
VascularWeb

 SS29. The Hemodynamic Impact of Balloon Angioplasty in Multiple Sclerosis Patients with Chronic Cerebrospinal Venous Insufficiency

Manish Mehta, R. Clement Darling, Sean P. Roddy, Paul B. Kreienberg, John B. Taggert, Kathleen J. Ozsvath, Jorge Rey, Dhiraj M. Shah
The Institute for Vascular Health and Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY.

OBJECTIVES: Recently an association has been made between Multiple Sclerosis (MS) and Chronic Cerebrospinal Venous Insufficiency (CCSVI) characterized by stenosis and reflux of the principal extracranial venous drainage including the Internal Jugular veins (IJV) and the Azygous veins (AZV). This is the first angiographic study to quantitatively analyze the impact of percutaneous balloon angioplasty (PTA) on flow dynamics across these lesions.

METHODS: 50 IJV form MS patients with CCSVI and 12 IJV from healthy volunteers underwent detailed angiographic evaluation. Technical components of all venograms were standardized. Quantitative analysis included the contrast time of flight (TOF) from the mid IJV to the superior vena cava, and the primary venous emptying time (PVET), quantified as >50% of venous emptying, from the IJV. The TOF and PVET were recorded in patients with CCSVI prior and subsequent to balloon angioplasty, as well in normal healthy subjects. All data was prospectively collected, and statistical analysis was performed using two-tailed Student’s test.

RESULTS: Of the 50 CCSVI-MS patients with IJV stenosis >70% and reflux underwent balloon angioplasty, technical success defined as <20% residual IJV stenosis was achieved in 78% (44/50). Table describes the pre- and post-angioplasty TOF and PVET in patients with CCSVI, as well as in healthy non-MS patients without any treatment. CCSVI patients were noted to have a significant improvement in both the TOF and PVET following balloon angioplasty that paralleled healthy non-MS subjects.

CONCLUSIONS: Results of this prospective pilot study suggest an association between MS and CCSVI, which results in abnormally elevated TOF and PEVT through the IJV. Furthermore, balloon angioplasty these lesions improves the hemodynamic parameters that are comparable to healthy non-MS patients.

AUTHOR DISCLOSURES: R. Darling, Nothing to disclose; P. B. Kreienberg, Nothing to disclose; M. Mehta, Nothing to disclose; K. J. Ozsvath, Nothing to disclose; J. Rey, Nothing to disclose; S. P. Roddy, Nothing to disclose; D. M. Shah, Nothing to disclose; J. B. Taggert, Nothing to disclose.

Table
MS patients with CCSVI
Healthy Non-MS
p-Value
Pre-Angioplasty
Post-Angioplasty
No Treatment
TOF
PVET
TOF
PEVT
TOF
PEVT
Mean Time (sec.)
5.28
12.45
2.45
6.44
2.33
6.10
<0.001
St. Dev.
2.52
10.0
0.79
2.05
0.42
0.58

 

Posted April 2012

Contact Us

Society for Vascular Surgery
633 North Saint Clair Street, 22nd Floor | Chicago, IL 60611
Phone: 312-334-2300 | 800-258-7188
Fax: 312-334-2320
Email: vascular@vascularsociety.org

Follow Us

YouTube

VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.