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.

Posted April 2012