Journal articles: 'CCSVI'

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Amato, MP, V. Saia, B. Hakiki, M. Giannini, L. Pastò, S. Zecchino, S. Lori, E. Portaccio, and M. Marinoni. "No association between chronic cerebrospinal venous insufficiency and pediatric-onset multiple sclerosis." Multiple Sclerosis Journal 18, no. 12 (April 18, 2012): 1791–96. http://dx.doi.org/10.1177/1352458512445943.

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Objective: Chronic cerebrospinal venous insufficiency (CCSVI) was hypothesized to play a causative role in multiple sclerosis (MS). The assessment of pediatric-onset MS (POMS) may provide a unique window of opportunity to study hypothesized risk factors in close temporal association with the onset of the disease. Methods: Internal jugular veins, vertebral veins and intracranial veins were evaluated with extracranial and intracranial ultrasound in 15 POMS and 16 healthy controls. Assessor’s blinding was maintained during the study. We considered subjects positive to CCSVI when at least two criteria were fulfilled. Results: CCSVI frequency was comparable between POMS and controls ( p > 0.05). Clinical features were not significantly different between CCSVI-positive and CCSVI-negative patients. Conclusions: Our findings add to previous data pointing against a causative role of CCSVI in MS.

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Metz, Luanne M., Jamie Greenfield, Ruth Ann Marrie, Nathalie Jette, Gregg Blevins, Lawrence W. Svenson, Katayoun Alikhani, Winona Wall, Raveena Dhaliwal, and Oksana Suchowersky. "Medical Tourism for CCSVI Procedures in People with Multiple Sclerosis: An Observational Study." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, no. 3 (February 4, 2016): 360–67. http://dx.doi.org/10.1017/cjn.2015.350.

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AbstractBackground: Many Canadians with multiple sclerosis (MS) have recently travelled internationally to have procedures for a putative condition called chronic cerebrospinal venous insufficiency (CCSVI). Here, we describe where and when they went and describe the baseline characteristics of persons with MS who participated in this non–evidence-based medical tourism for CCSVI procedures. Methods: We conducted a longitudinal observational study that used online questionnaires to collect patient-reported information about the safety, experiences, and outcomes following procedures for CCSVI. A convenience sample of all Albertans with MS was recruited between July 2011 and March 2013. Results: In total, 868 individuals enrolled; 704 were included in this cross-sectional, baseline analysis. Of these, 128 (18.2%) participants retrospectively reported having procedures for CCSVI between April 2010 and September 2012. The proportion of participants reporting CCSVI procedures declined from 80 (62.5%) in 2010, to 40 (31.1%) in 2011, and 8 (6.3%) in 2012. In multivariable logistic regression analysis, CCSVI procedures were independently associated with longer disease duration, secondary progressive clinical course, and greater disability status. Conclusions: Although all types of people with MS pursued procedures for CCSVI, a major driver of participation was greater disability. This highlights that those with the greatest disability are the most vulnerable to unproven experimental procedures. Participation in CCSVI procedures waned over time possibly reflecting unmet expectations of treated patients, decreased media attention, or that individuals who wanted procedures had them soon after the CCSVI hypothesis was widely publicized.

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Van Den Berg, P. J., and L. H. Visser. "Extra- and Transcranial Echo Colour Doppler in the Diagnosis of Chronic Cerebrospinal Venous Insufficiency." Phlebology: The Journal of Venous Disease 27, no. 1_suppl (March 2012): 107–13. http://dx.doi.org/10.1258/phleb.2011.012s04.

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A new venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis (MS). It is a vascular condition characterized by an impaired cerebrospinal venous drainage due to obstructions in the main extracranial cerebrovenous outflow routes (i.e. internal jugular veins [IJV] and/or azygos veins). In this review, the studies which assessed the prevalence of CCSVI in MS by echo colour Doppler (ECD) will be discussed. The technical aspects of determination of the five CCSVI criteria: (1) reflux in the IJV and/or vertebral veins in supine and upright position, (2) reflux in the deep cerebral veins, (3) high-resolution B-mode proximal IJV stenosis, (4) flow not Doppler detectable in IJVs and/or vertebral veins (VVs) and (5) reverted postural control of the main cerebrovenous outflow pathway are described in detail. We conclude that so far there are many studies with contradictory results, and as yet a strong scientific base to support the evidence for a causative relationship of CCSVI and MS is lacking. Recent studies call into question the validity of using ECD as a proper and reliable test for the diagnosis of CCSVI. One explanation for the variety in interpretation of the individual CCSVI criteria, with the wide-ranging percentages CCSVI, could be the different methods by using ECD to determine various criteria.

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Comi, G., MA Battaglia, A. Bertolotto, M. Del Sette, A. Ghezzi, G. Malferrari, M. Salvetti, et al. "Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study." Multiple Sclerosis Journal 19, no. 11 (September 6, 2013): 1508–17. http://dx.doi.org/10.1177/1352458513501231.

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Background: Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a possible cause of multiple sclerosis (MS). Objectives: The CoSMo study evaluated the association between CCSVI and MS. Methods: The primary end-point of this multicentric, case-control study was to compare the prevalence of CCSVI between patients with MS, patients with other neurodegenerative diseases (ONDs) and healthy controls (HCs). Color-coded duplex sonography was performed by a sonologist and the images were sent to one of three central sonologists for a second reading. Agreement between local and central sonologists or, in case of disagreement, the predominant judgment among the three central readers, was required for a diagnosis of CCSVI. All readings, data collection and analysis were blinded. Results: The study involved 35 MS centers across Italy and included 1874 subjects aged 18–55. 1767 (94%) were evaluable: 1165 MS patients, 226 patients with ONDs and 376 HCs. CCSVI prevalence was 3.26%, 3.10% and 2.13% for the MS, OND and HC groups, respectively. No significant difference in CCSVI prevalence was found amongst the three cohorts (MS versus HC, OR = 1.55, 95%CI = 0.72–3.36, p = 0.30; OND versus HC, OR = 1.47, 95%CI = 0.53–4.11, p = 0.46; MS versus OND, OR = 1.05, 95%CI = 0.47–2.39, p = 0.99). High negative and low positive agreement was found between the local and centralized readers. Conclusions: CCSVI is not associated with MS.

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Leone, Maurizio A., Olga Raymkulova, Piergiorgio Lochner, Laura Bolamperti, Gianandrea Rivadossi, Alessandro Stecco, Giuseppe Zaccala, et al. "Chronic cerebrospinal venous insufficiency is not associated with chronic venous disorders: A case–control study." Phlebology: The Journal of Venous Disease 30, no. 10 (July 31, 2014): 736–38. http://dx.doi.org/10.1177/0268355514544782.

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Objectives To evaluate the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and the presence of a Chronic Venous Disorder (CVD). Method We included 55 subjects with CCSVI aged >18 years, and 186 controls without CCSVI. Each subject was evaluated with color Doppler sonography in accordance with Zamboni’s five criteria, examined by two neurologists and interviewed with an ad-hoc designed form. The neurologists and the sonographers were mutually blinded. CVD were classified according to CEAP. Results Mean age was 42 years (SD = 9) in cases and 43 years (10) in controls ( p = ns). The odds ratios in subjects CCSVI were 0.6 (0.2–2.2) for CEAP 1, 0.9 (0.2–4.5) for CEAP 2, and 1.0 (0.6–1.9) for family history of varicose veins. The prevalence of CVD and, family history of varicose veins, was similar between cases and controls for each Zamboni criterion. Conclusions We found no association of CCSVI with the presence of CVD or family history of varicose veins.

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Valdueza, José M., Florian Doepp, Stephan J. Schreiber, Bob W. van Oosten, Klaus Schmierer, Friedemann Paul, and Mike P. Wattjes. "What Went Wrong? the Flawed Concept of Cerebrospinal Venous Insufficiency." Journal of Cerebral Blood Flow & Metabolism 33, no. 5 (February 27, 2013): 657–68. http://dx.doi.org/10.1038/jcbfm.2013.31.

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In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency (‘CCSVI’). The diagnosis of ‘CCSVI’ is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of ‘CCSVI’ could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the ‘CCSVI’ concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the ‘CCSVI’ concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat ‘CCSVI’ in the care of MS patients, outside of the setting of scientific research.

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Thapar, A., T. Lane, R. Nicholas, T. Friede, M. Ellis, J. Assenheim, I. J. Franklin, and A. H. Davies. "Systematic review of sonographic chronic cerebrospinal venous insufficiency findings in multiple sclerosis." Phlebology: The Journal of Venous Disease 26, no. 8 (October 23, 2011): 319–25. http://dx.doi.org/10.1258/phleb.2011.011098.

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Objective The sonographic findings of chronic cerebrospinal venous insufficiency (CCSVI) are used by some as selection criteria for venography. We performed a systematic review to establish the prevalence and strength of association between sonographic CCSVI and multiple sclerosis (MS). Method Two reviewers searched PubMed and EMBASE from 1948 to date using the keywords ‘chronic cerebrospinal venous insufficiency’ according to PRISMA guidelines. Results Four cross-sectional studies met the criteria for inclusion. The prevalence of CCSVI ranged from 7% to 100% in MS patients and from 2% to 36% in healthy controls. Diagnostic odds ratios for MS varied between 2 and 26, 499 ( I 2 = 94%). Sensitivities of CCSVI for MS varied between 7% and 100% ( I 2 = 98%). Specificities varied between 64% and 100% ( I 2 = 95%). Conclusion There is substantial variation in the strength of association between CCSVI and MS beyond that explained by demographic differences or sonographer training. Reliable evidence on which to base decisions requires sonographic consensus and assessment of the reproducibility of individual criteria between trained sonographers.

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Lugli, M., M. Morelli, S. Guerzoni, and O. Maleti. "The Hypothesis of Pathophysiological Correlation between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis: Rationale of Treatment." Phlebology: The Journal of Venous Disease 27, no. 1_suppl (March 2012): 178–86. http://dx.doi.org/10.1258/phleb.2012.012s24.

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Background: The possible role of the venous system in the pathogenesis of chronic neurodegenerative diseases has been hypothesized for decades. Quite recently, the description of a venous condition defined as chronic cerebrospinal venous insufficiency (CCSVI) and its strong association with multiple sclerosis (MS) has brought back the attention of the scientific community to the hypothesis of an aetiological or concomitant role of an altered venous function in the occurrence of this pathology. CCSVI is identified by sonographic criteria, thus the indication for its possible treatment is based on ultrasound findings. Method: We retrospectively examined 167 consecutive patients affected by clinically defined MS and CCSVI, identified by ultrasound assessment by the presence of at least two sonographic criteria. Ultrasonographic diagnosis of CCSVI was then integrated by venography and intravascular ultrasound examination (in 43 patients). Patients were all submitted to endovascular procedure (venoplasty). Results In 37% of cases there was no correspondence between the preoperative ultrasound assessment and the venographic findings. In the event of incongruity between venography and sonography, the intravascular ultrasound examination investigation, when performed, confirmed ultrasound findings in 42% of cases and venography results in 58%. At one month in 12% of cases ultrasound assessment showed the persistence of altered flux. In 67% of cases patients reported subjective amelioration, regarding non-specific symptoms. Conclusion: The pathophysiology of CCSVI is yet to be defined. The superior cava venous system is highly complex in terms of anatomy and possible anomalies, as well as its haemodynamic mechanisms. Further studies are required to define the parameters of diagnosis and treatment of CCSVI.

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Thapar, A., T. R. A. Lane, V. Pandey, J. Shalhoub, O. Malik, M. Ellis, I. J. Franklin, R. Nicholas, and A. H. Davies. "Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency." Phlebology: The Journal of Venous Disease 26, no. 6 (July 29, 2011): 254–56. http://dx.doi.org/10.1258/phleb.2011.011052.

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Chronic cerebrospinal venous insufficiency (CCSVI) is a hypothesis through which cerebral venous drainage abnormalities contribute towards the pathogenesis of multiple sclerosis. CCSVI venoplasty is already practised worldwide. We report the case of a 33-year-old lady with multiple sclerosis who underwent left internal jugular venoplasty resulting in iatrogenic jugular thrombosis requiring open thrombectomy for symptom relief. This occurred without insertion of a stent and while fully anticoagulated. Clinicians should be aware that endovenous treatment of CCSVI could cause paradoxical deterioration of cerebral venous drainage. Patients with complications post venoplasty are now presenting to geographically distant vascular units.

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Beggs, C., S. Shepherd, and P. Zamboni. "Cerebral venous outflow resistance and interpretation of cervical plethysmography data with respect to the diagnosis of chronic cerebrospinal venous insufficiency." Phlebology: The Journal of Venous Disease 29, no. 3 (October 11, 2012): 191–99. http://dx.doi.org/10.1258/phleb.2012.012039.

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Objective: While chronic cerebrospinal venous insufficiency (CCSVI) can be characterized using cervical plethysmography, much remains unknown about the haemodynamics associated with this procedure. The aim of the study was therefore to gain a deeper understanding of the observed haemodynamics. Method: Forty healthy controls and 44 CCSVI patients underwent cervical plethysmography, which involved placing a strain-gauge collar around their necks and tipping them from the upright (90°) to supine position (0°) in a chair. Once stabilized, they were returned to the upright position, allowing blood to drain from the neck. A mathematical model was used to calculate the hydraulic resistance of the extracranial venous system for each subject in the study. Results: The mean hydraulic resistance of the extracranial venous system was 10.28 (standard deviation [SD] 5.14) mmHg.s/mL in the healthy controls and 16.81 (SD 9.22) in the CCSVI patients ( P < 0.001). Conclusions: The haemodynamics of the extracranial venous system are greatly altered in CCSVI patients.

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Scalise, Filippo, Eugenio Novelli, Massimiliano Farina, Luciano Barbato, and Salvatore Spagnolo. "Venous Hemodynamic Insufficiency Severity Score variation after endovascular treatment of chronic cerebrospinal venous insufficiency." Phlebology: The Journal of Venous Disease 30, no. 4 (February 14, 2014): 250–56. http://dx.doi.org/10.1177/0268355514524193.

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Introduction Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the internal jugular veins (IJVs) and/or azygos veins with disturbed flow and formation of collateral venous channels. The presence of CCSVI has been associated with multiple sclerosis (MS). Percutaneous venous angioplasty (PVA) has been proposed to improve extracranial outflow; however, a non-invasive, post-procedural follow-up outcome measure has not been established. Aim of the study To evaluate the short-term hemodynamic follow-up of CCSVI after PVA using color Doppler ultrasound (CDU) and to investigate whether hemodynamic variation correlated with clinical variation. Materials and methods Forty-five patients affected by MS with confirmed CCSVI underwent IJVs PVA. Venous hemodynamic (VH) parameters indicative of CCSVI and the Venous Hemodynamic Insufficiency Severity Score (VHISS) were evaluated by CDU at baseline and 3 months post-PVA. Concurrently, the MS-related disability status (EDSS) was evaluated. Results The VH parameters and VHISS 3 months after IJVs PVA significantly decreased: the VH parameters −32.1% and the VHISS −33.8% ( p < 0.001). The EDSS score 3 months after IJVs PVA was significantly lower than the baseline (−5.5%, p < 0.001). Using the median value of the VHISS variation as the cut-off, we were able to identify two groups of patients: responders, group A; and non-responders, group B. The EDSS score variation at 3 months was 0.310 in group A and 0.275 in group B ( p = 0.746). Conclusions CCSVI endovascular treatment can induce an improvement in VH parameters and the VHISS. The neurological disability score (EDSS) also improved after PVA; however, there was no correlation to the VHISS variation after PVA, MS type and duration.

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Ghezzi, A., P. Annovazzi, MP Amato, E. Capello, P. Cavalla, E. Cocco, M. Falcini, et al. "Adverse events after endovascular treatment of chronic cerebro-spinal venous insufficiency (CCSVI) in patients with multiple sclerosis." Multiple Sclerosis Journal 19, no. 7 (February 4, 2013): 961–63. http://dx.doi.org/10.1177/1352458513475491.

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Although it is debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients undergo endovascular treatment (ET) of CCSVI. A study is ongoing in Italy to evaluate the clinical outcome of ET. Severe adverse events (AEs) occurred in 15/462 subjects at a variable interval after ET: jugular thrombosis in seven patients, tetraventricular hydrocephalus, stroke, paroxysmal atrial fibrillation, status epilepticus, aspiration pneumonia, hypertension with tachicardia, or bleeding of bedsore in the remaining seven cases. One patient died because of myocardial infarction 10 weeks after ET. The risk of severe AEs related to ET for CCSVI must be carefully considered.

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Lee, Byung Boong. "Multiple Sclerosis & CCSVI." Journal of Theoretical and Applied Vascular Research 3, no. 2 (2018): 101–2. http://dx.doi.org/10.24019/jtavr.57.

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Barkhof, Frederik, and Mike P. Wattjes. "CCSVI deconstructed and discarded." Nature Reviews Neurology 9, no. 12 (November 12, 2013): 661–62. http://dx.doi.org/10.1038/nrneurol.2013.228.

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Reekers, Jim A. "IDEAL for CCSVI Research." Archives of Neurology 69, no. 7 (July 1, 2012): 939. http://dx.doi.org/10.1001/archneurol.2012.322.

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Fragoso, Yára Dadalti. "The internet racing ahead of the scientific evidence: the case of "liberation treatment" for multiple sclerosis." Arquivos de Neuro-Psiquiatria 69, no. 3 (June 2011): 525–27. http://dx.doi.org/10.1590/s0004-282x2011000400022.

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Multiple sclerosis (MS) is a chronic neurological disease that typically affects young adults. A recent publication suggested that MS might originate from insufficient blood drainage in certain areas of the central nervous system. The condition was named chronic cerebrospinal venous insufficiency (CCSVI). Other papers have not confirmed these findings and, therefore, the matter remains controversial. Nineteen months after the original publication on CCSVI and MS, another 22 papers have been published addressing the matter. No clinical trials have been carried out on the subject and there is no evidence-based indication to perform surgical vascular procedures in MS patients. However, over the same nineteen-month period, the internet discussion on the subject of CCSVI and MS has led to countless websites advertising treatment using vascular surgery for patients with MS all over the world. The treatment based on the CCSVI theory has appealingly been called "liberation treatment", thus making it difficult to explain to patients why a treatment that has been highly praised (on the internet) cannot be recommended based on partial medical results that await confirmation.

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Zamboni, P., and R. Galeotti. "The chronic cerebrospinal venous insufficiency syndrome." Phlebology: The Journal of Venous Disease 25, no. 6 (November 24, 2010): 269–79. http://dx.doi.org/10.1258/phleb.2010.009083.

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Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.

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Chambers, Brian, Jayne Chambers, Heather Cameron, and Richard Macdonell. "Chronic cerebrospinal venous insufficiency is not more prevalent in patients with mild multiple sclerosis: a sonographer-blinded, case-control ultrasound study." Multiple Sclerosis Journal 19, no. 6 (September 7, 2012): 749–56. http://dx.doi.org/10.1177/1352458512459986.

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Objectives: We designed a prospective case-control study of patients with clinically isolated syndrome (CIS) and Relapsing–Remitting Multiple Sclerosis (RRMS) with an Expanded Disability Status Score (EDSS) of ≤2, compared with age-and-sex-matched healthy controls, to test the hypothesis that chronic cerebrospinal venous insufficiency (CCSVI) is more prevalent in patients with CIS or mild MS. Methods: All subjects were examined using a Siemens Antares duplex ultrasound machine. The internal jugular, vertebral and intracranial veins were studied in subjects in both supine and sitting postures. The sonographer was blind to the subject’s clinical status. Measures included the criteria proposed by Zamboni and volume flow. Presence of CCSVI was defined as ≥2 Zamboni criteria. Results: Seventy patient-control pairs were recruited, with 11 males and 59 females in each group. Only one subject, a control, satisfied the Zamboni definition of CCSVI; however, 19 patients and 13 controls had abnormalities as defined by Zamboni, the difference largely caused by a higher prevalence in patients of internal jugular vein (IJV) stenosis, defined as a cross-sectional area ≤0.3cm2. This difference disappeared with a more rigorous stenosis definition. Further analysis revealed there was IJV valve variation in seven patients and one control. Conclusions: Our findings indicate that CCSVI, as defined by the Zamboni ultrasound criteria, is not present in CIS and mild RRMS (EDSS ≤2), providing further evidence that CCSVI does not have a causal role in MS; however, we found an apparent increase in IJV variation in patients with CIS or mild MS that would warrant further investigation.

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Reekers, Jim. "A Swan Song for CCSVI." CardioVascular and Interventional Radiology 37, no. 2 (January 9, 2014): 287–88. http://dx.doi.org/10.1007/s00270-013-0833-6.

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Mayer, C. A., and U. Ziemann. "CCSVI: Is Blinding the Key?" European Journal of Vascular and Endovascular Surgery 43, no. 1 (January 2012): 124–25. http://dx.doi.org/10.1016/j.ejvs.2011.09.014.

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Williams, Michael A., and Arun Venkatesan. "IDEAL for CCSVI Research—Reply." Archives of Neurology 69, no. 7 (July 1, 2012): 939. http://dx.doi.org/10.1001/archneurol.2012.325.

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Ghahari, Setareh, and Susan J. Forwell. "Social Media Representation of Chronic Cerebrospinal Venous Insufficiency Intervention for Multiple Sclerosis." International Journal of MS Care 18, no. 2 (March 1, 2016): 49–57. http://dx.doi.org/10.7224/1537-2073.2014-073.

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Background: We conducted a rigorous review of videos related to multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) treatment posted by people with MS on one social media website (YouTube) that describe symptoms before and after the surgical procedure, as well as videos presented by health-care professionals (HCPs). Methods: All relevant videos posted from December 2009 to July 2011 were downloaded, viewed, and systematically organized. Categorical data were classified, and dominant messages were gleaned. Results: A total of 1789 videos were extracted. A total of 621 videos by people with MS and 238 by HCPs were included. Eighty-six percent of people with MS anecdotally reported experiencing some improvement in at least one symptom. The most common message was that “CCSVI is not a miracle but worth trying.” Most HCPs posting videos recommended the procedure but called for continued research. Conclusions: Social media are conveying an anecdotal favorable message about CCSVI treatment for MS. The relative absence of videos offering a negative or more balanced perspective is a concern. Social persuasion through these videos creates a strong positive impression of CCSVI treatment, but the videos do not acknowledge the lack of supporting scientific evidence and the possible role of the placebo effect. Given the strong influence of social media on health-care decision making, researchers and clinicians should actively use social media to reach out to people with MS and describe the state of the evidence for MS treatments, both positive and negative.

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Benjaminy, Shelly, Cody Lo, Judy Illes, and Anthony Traboulsee. "Reflections on translation." Neurology: Clinical Practice 8, no. 3 (May 23, 2018): 232–39. http://dx.doi.org/10.1212/cpj.0000000000000462.

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BackgroundWe sought to characterize the perspectives of participants in Canada's phase I/II chronic cerebrospinal venous insufficiency (CCSVI) clinical trial prior to and after the disclosure of trial results.MethodsThis was a researcher-administered survey of individuals who participated in Canada's CCSVI trial (Clincialtrials.gov,NCT01864941) about their (1) motivations for participating, (2) understanding of the trial process, and (3) perspectives on the social value of the trial.ResultsA total of 63 participants completed the survey. Participants were motivated to participate by altruism (mean score = 4.56 out of 5) and a desire to access the intervention in Canada (mean score = 3.63 out of 5). Many participants expected medical benefits, such as partial disease reversal (mean score = 3.32 out of 5). Participants felt strongly that the crossover trial design promoted fairness (mean score = 4.65 out of 5). Participants' familiarity with the CCSVI controversy increased significantly after the results were revealed (p= 0.0001). Despite negative trial results, participants still felt that the trial was an appropriate use of tax dollars (mean score = 4.68 out of 5). Many (38%) upheld the belief that further CCSVI research is necessary (responses of 4 out of 5 or higher).ConclusionsThere is a strong movement in science today to ensure that research agendas reflect the perspectives of multiple stakeholders, including research participants. While previous work suggests that negative findings adversely affect trust in science, the perspectives of participants in this study demonstrate that good trial design and resilience can prevail over expected tensions.

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Burton, Jodie M., Katayoun Alikhani, Mayank Goyal, Fiona Costello, Chris White, David Patry, Robert Bell, and Michael D. Hill. "Complications in MS Patients after CCSVI Procedures Abroad (Calgary, AB)." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 38, no. 5 (September 2011): 741–46. http://dx.doi.org/10.1017/s0317167100054123.

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ABSTRACT:Background:The “chronic cerebrospinal venous insufficiency” or “CCSVI” hypothesis, namely that multiple sclerosis (MS) is caused by abnormalities in the azygous and internal jugular veins with subsequent alterations in venous hemodynamics in the central nervous system, has been a dominant topic in MS care in Canada over the past year. Although there is no methodologically rigorous evidence to support this hypothesis presently, a considerable number of MS patients have undergone endovascular CCSVI procedures. Such procedures include angioplasty or stent placement in jugular and azygous veins. The safety and efficacy of these procedures is unknown, but not without risk.Methods:Chart and patient review of five patients with confirmed MS followed in Calgary were undertaken after patients came to medical attention by referral or admission secondary to complications believed to be associated with CCSVI procedures.Results:Complications upon investigation and review included internal jugular vein stent thrombosis, cerebral sinovenous thrombosis, stent migration, cranial nerve injury and injury associated with venous catheterization.Conclusions:As the debate about CCSVI and its relationship to MS continues, the complications and risks associated with venous stenting and angioplasty in jugular and azygous veins are becoming clearer. As increasing numbers of MS patients are seeking such procedures, these five cases represent the beginning of a wave of complications for which standardized care guidelines do not exist. Our experience and that of our colleagues will be used to develop guidelines and strategies to monitor and manage these patients as their numbers increase.

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Miller, Aaron. "Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis—A Medical, Sociological, and Media Controversy." US Neurology 07, no. 02 (2011): 84. http://dx.doi.org/10.17925/usn.2011.07.02.84.

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In 2009, Zamboni et al. coined the term chronic cerebrospinal venous insufficiency (CCSVI). On the basis of transcranial and extra-cranial color-coded Doppler ultrasonography, they operationally defined CCSVI as occurring when at least two out of five abnormalities were present. They claimed to find CCSVI in 100 % of 109 individuals with multiple sclerosis (MS) and in none of 177 healthy controls. Zambonis group subsequently reported an uncontrolled treatment trial of cerebral venoplasty, which was termed the liberation procedure, and claimed that the procedure benefited people with MS. The Zamboni reports were received with considerable skepticism, regarding both their biological plausibility and the claims of 100 % sensitivity, specificity, positive predictive value, and negative predictive value. No investigators have subsequently been able to replicate the Zamboni observations. Although some additional reports have indicated finding venous abnormalities in more MS patients than in other groups, most have either found no association of CCSVI with MS, or else have found substantial numbers of controls, either healthy or with other neurologic disease, to have the abnormalities. The original Zamboni reports were widely publicized in the mainstream media, especially in Canada, and sparked a raging controversy in the social media. Patients clamored for trials of cerebral venoplasty and others demanded its availability or traveled around the globe to undergo the procedure. The Canadian Institutes of Health Research have now solicited proposals for a Phase I/II clinical trial. At this point, additional scientific studies, including many funded by the National Multiple Sclerosis Society and the Multiple Sclerosis Society of Canada, are moving toward completion and will hopefully allow a proper judgment of the validity of the concept of CCSVI in relationship to MS. In the meantime, it is important that physicians remain respectful of patients views, but that they are not reticent about expressing their own professional opinions based on available evidence, while emphasizing the importance of proper scientific research.

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Miller, Aaron. "Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis - A Medical, Sociological and Media Controversy." European Neurological Review 7, no. 1 (2012): 10. http://dx.doi.org/10.17925/enr.2012.07.01.10.

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In 2009, Zamboni et al. coined the term “chronic cerebrospinal venous insufficiency” (CCSVI). On the basis of transcranial and extra-cranial colour-coded Doppler ultrasonography, they operationally defined CCSVI as occurring when at least two out of five “abnormalities” were present. They claimed to find CCSVI in 100 % of 109 individuals with multiple sclerosis (MS) and in none of 177 healthy controls. Zamboni’s group subsequently reported an uncontrolled treatment trial of cerebral venoplasty, which was termed the “liberation procedure” and claimed that the procedure benefited people with MS. The Zamboni reports were received with considerable skepticism, regarding both their biological plausibility and the claims of 100 % sensitivity, specificity, positive predictive value and negative predictive value. No investigators have subsequently been able to replicate the Zamboni observations. Although some additional reports have indicated finding venous abnormalities in more MS patients than in other groups, most have either found no association of CCSVI with MS, or else have found substantial numbers of controls, either healthy or with other neurological disease, to have the abnormalities. The original Zamboni reports were widely publicised in the mainstream media, especially in Canada and sparked a raging controversy in the social media. Patients clamoured for trials of cerebral venoplasty and others demanded its availability or travelled around the globe to undergo the procedure. The Canadian Institutes of Health Research have now solicited proposals for a Phase I/II clinical trial. At this point, additional scientific studies, including many funded by the National Multiple Sclerosis Society and the Multiple Sclerosis Society of Canada, are moving toward completion and will hopefully allow a proper judgment of the validity of the concept of CCSVI in relation to MS. In the meantime, it is important that physicians remain respectful of patients’ views, but that they are not reticent about expressing their own professional opinions based on available evidence, while emphasising the importance of proper scientific research.

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27

Alpini, D., P. M. Bavera, F. Di Berardino, S. Barozzi, and A. Cesarani. "Bilateral Sudden Sensorineural Hearing Loss and Chronic Venous Cerebrospinal Insufficiency: A Case Report." Phlebology: The Journal of Venous Disease 28, no. 5 (April 5, 2012): 231–33. http://dx.doi.org/10.1258/phleb.2012.012009.

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Objectives: We report a case of bilateral sudden sensorineural hearing loss (SSHL) in a patient suffering from chronic venous cerebrospinal insufficiency (CCSVI). Methods: Audiometric testing confirmed bilateral sensorineural hearing loss with hypoexcitability to caloric stimulation on the left side and echo-colour Doppler examination showed abnormal cerebral venous deficiency. Results: The patient's condition improved after 15 days following medical treatment. Conclusions: CCSVI may explain the anatomical background which provides a predisposing factor for SSHL although further studies are needed to verify whether this observation is casual or coincidental.

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Doležal, Ondřej, D. Horáková, Z. Gdovinová, and J. Szilasiová. "Serious Complication of Percutaneous Angioplasty with Stent Implantation in so Called "Chronic Cerebrospinal Venous Insufficiency" in Multiple Sclerosis Patient." Prague Medical Report 113, no. 4 (2012): 289–93. http://dx.doi.org/10.14712/23362936.2015.12.

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We report female patient, age 51, with clinically definitive multiple sclerosis (CDMS) since 1998, who underwent two PTA procedures with stent implantation for CCSVI in 2010. Expanded disability status scale (EDSS) worsened since the procedure from 4.5 to 6. Total number of three stents was implanted (two of them in the right internal jugular vein). In six month time, in 2011, patient was referred for independent examination by computer tomography (CT) phlebography for right-sided neck pain. Dislocation of stents on the right side and thrombosis of left sided stent was found. Conservative approach was used so far. Our short report is showing possible complications of PTA and stenting in jugular veins in so called CCSVI and bringing information about neurological state (EDSS) worsening in a subject. Continuation of stent migration in the future is probable, possibly resulting in pulmonary embolism with fatal risk for the patient. We strongly ask for restriction of PTA procedure in so called CCSVI, which concept was not proven to be relevant to MS.

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29

Morovic, Sandra, and Paolo Zamboni. "CCSVI is associated with multiple sclerosis." Neurological Research 34, no. 8 (October 2012): 770–79. http://dx.doi.org/10.1179/1743132812y.0000000035.

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30

Oger, Joel, and Mona Alkhajawah. "CCSVI: Hope, Hype or Snake Oil?" Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 37, no. 6 (November 2010): 716. http://dx.doi.org/10.1017/s0317167100051349.

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31

Zamboni, P., B. Weinstock-Guttman, and R. Zivadinov. "Regarding CCSVI: Is Blinding the Key?" European Journal of Vascular and Endovascular Surgery 43, no. 1 (January 2012): 126. http://dx.doi.org/10.1016/j.ejvs.2011.10.012.

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32

Radak, Djordje, Jovo Kolar, Dragan Sagic, Nenad Ilijevski, Slobodan Tanaskovic, Nikola Aleksic, Jelena Marinkovic, et al. "Percutaneous angioplasty of internal jugular and azygous veins in patients with chronic cerebrospinal venous insufficiency and multiple sclerosis: early and mid-term results." Phlebology: The Journal of Venous Disease 29, no. 6 (May 6, 2013): 367–75. http://dx.doi.org/10.1177/0268355513481766.

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Purpose: To assess the safety of endovascular treatment of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis (MS). Materials and Methods: A total of 72 patients with CCSVI and MS (44 with relapsing remitting – RR, 4 with primary progressive, 20 with secondary progressive and 4 with benign MS) underwent percutaneous angioplasty. Outcome measures were colour Doppler ultrasonography parameters, gradient pressure at the vein abnormality level, postoperative complications, re-stenosis, disease severity scored by means of Expanded Disability Status Scale (EDSS) and patients’ assumption of disease status. Controls were done after one month on 72 patients, six months on 69 patients and one year on 61 patients, respectively (the average follow-up was 11 months). Results: There were no postoperative complications. Colour Doppler ultrasonography showed significant improvement in cross-sectional area parameters ( P < 0.05) and significant decrease in confluence velocity values ( P < 0.05). Postoperative gradient pressure decreased, in internal jugular vein (IJV) significantly ( P < 0.05). Re-stenosis appeared in 5.3% of patients. EDSS score was significantly improved ( P < 0.01) and about half of patients reported significant or mild improvement in disease status and none of them worsening of symptoms. Conclusion: Endovascular treatment of the IJV and azygous veins in patients with CCSVI and MS is a safe procedure with no post-procedural complications followed by significant improvement of IJV flow haemodynamic parameters and decrease in the EDSS score. Whether CCSVI percutaneous treatment might affect clinical improvement in patients suffering from MS is yet to be seen after completion of major multicentric clinical trials, still it seems like that this procedure is not negligible.

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33

Scalise, F., M. Farina, M. Manfredi, C. Auguadro, and E. Novelli. "Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound." Phlebology: The Journal of Venous Disease 28, no. 8 (May 6, 2013): 409–17. http://dx.doi.org/10.1258/phleb.2012.012079.

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Objectives Chronic cerebrospinal venous insufficiency (CCSVI) is a malformative condition characterized by several anomalies of the azygos and/or internal jugular veins (IJVs). Recommended diagnosis of CCSVI is performed with colour-Doppler (CD) sonography. Though catheter venography (CV) is considered as the gold standard for determining vascular anatomy, its uniplanar point of view does not allow an overall evaluation of endoluminal structures. This limit could be addressed by intravascular ultrasound (IVUS). The aim of this report is to evaluate, in patients with multiple sclerosis (MS), the accuracy of CD sonography and CV versus IVUS in estimating the diameter and the cross-sectional area (CSA) of the IJVs and in detecting jugular endoluminal malformations (JEM). Method Forty-five MS patients with CCSVI, diagnosed by CD sonography, were submitted to CV during IJVs angioplasty. Twenty-five subjects were also examined with IVUS. The IJVs maximum diameter (MAXD) and CSA were estimated. CD and CV data were compared with IVUS data with the Bland-Altman method. Results The mean difference in IJV MAXD recorded by CD and IVUS was —0.5 mm. The mean difference in IJV MAXD recorded by CV and IVUS was 3.36 mm. The mean difference in IJV CSA recorded by CD and IVUS was —11.2 mm2. JEM recorded by IVUS were detected by CD sonography and CV with 88% and 32% accuracy, respectively. Conclusions CV was significantly inferior to CD sonography and IVUS in detecting JEM. Differences between IVUS and CD sonography in detecting JEM and in quantifying jugular diameters were not significant. The IJV CSA was underestimated by CD sonography compared with IVUS. CD sonography was proven to be important in the anatomical characterization of CCSVI, providing useful information for correct intravascular treatment.

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34

Bruno, Aldo. "Neck And Brain Venous Lesions In Meniere’s Disease." Angiology & Vascular Surgery 5, no. 3 (December 31, 2020): 1–7. http://dx.doi.org/10.24966/avs-7397/100053.

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Objectives: The authors evaluate the incidence of Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) in patients with Meniere’s Disease (MD). Methods: Between April 2013 and April 2020, 622 patients with diagnosis of Meniere’s Disease were included, all were submitted to duplex ultrasound and Magnetic Resonance Angiography (MRI) with TOF 2D and 3D reconstruction and compared to a control population. Results: Chronic Cerebo-Spinal Venous Insufficiency (CCSVI) was demonstrated in 81.4% of patients with Meniere’s disease vs. 12.7% of the volunteers. Visible defects were present in 90% of the cases. There was a high correlation, round 90%, between ultrasound exam and MRI. Conclusion: Our results suggest that there is a high incidence of neck and brain veins in patients suffering of Menière's disease.

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35

Baracchini, Claudio, Matteo Atzori, and Paolo Gallo. "CCSVI and MS: no meaning, no fact." Neurological Sciences 34, no. 3 (May 9, 2012): 269–79. http://dx.doi.org/10.1007/s10072-012-1101-2.

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36

Shaw, Gina. "Two New Papers Question MS-CCSVI Theory." Neurology Today 10, no. 19 (October 2010): 40–41. http://dx.doi.org/10.1097/01.nt.0000390228.16602.16.

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37

Reekers, J. A. "CCSVI and MS: A Never-Ending Story." European Journal of Vascular and Endovascular Surgery 43, no. 1 (January 2012): 127–28. http://dx.doi.org/10.1016/j.ejvs.2011.09.019.

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38

Mehta, M. "Review of CCSVI and MS for EJVES." European Journal of Vascular and Endovascular Surgery 43, no. 1 (January 2012): 131. http://dx.doi.org/10.1016/j.ejvs.2011.10.019.

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39

Rasman, Alessandro. "CCSVI in multiple sclerosis: is it the end?" Phlebological Review 25, no. 1 (2017): 91–92. http://dx.doi.org/10.5114/pr.2017.72539.

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40

Singh, Ajay Vikram, and Paolo Zamboni. "Anomalous Venous Blood Flow and Iron Deposition in Multiple Sclerosis." Journal of Cerebral Blood Flow & Metabolism 29, no. 12 (September 2, 2009): 1867–78. http://dx.doi.org/10.1038/jcbfm.2009.180.

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Multiple sclerosis (MS) is primarily an autoimmune disorder of unknown origin. This review focuses iron overload and oxidative stress as surrounding cause that leads to immunomodulation in chronic MS. Iron overload has been demonstrated in MS lesions, as a feature common with other neurodegenerative disorders. However, the recent description of chronic cerebrospinal venous insufficiency (CCSVI) associated to MS, with significant anomalies in cerebral venous outflow hemodynamics, permit to propose a parallel with chronic venous disorders (CVDs) in the mechanism of iron deposition. Abnormal cerebral venous reflux is peculiar to MS, and was not found in a miscellaneous of patients affected by other neurodegenerative disorders characterized by iron stores, such as Parkinson's, Alzheimer's, amyotrophic lateral sclerosis. Several recently published studies support the hypothesis that MS progresses along the venous vasculature. The peculiarity of CCSVI-related cerebral venous blood flow disturbances, together with the histology of the perivenous spaces and recent findings from advanced magnetic resonance imaging techniques, support the hypothesis that iron deposits in MS are a consequence of altered cerebral venous return and chronic insufficient venous drainage.

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41

Sadovnick, A. Dessa, Irene M. Yee, Kristen Attwell-Pope, Glenn Keyes, Lucas Kipp, and Anthony L. Traboulsee. "Patient-Reported Benefits of Extracranial Venous Therapy: British Columbia CCSVI Registry." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 3 (March 8, 2017): 246–54. http://dx.doi.org/10.1017/cjn.2017.27.

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AbstractObjective Chronic cerebrospinal venous insufficiency (CCSVI) has been hypothesized to be a risk factor for multiple sclerosis (MS). Venoplasty has been proposed as a treatment for CCSVI. The aim of our study was to gain a better understanding of the “real-world” safety and longitudinal effectiveness of venoplasty Methods: British Columbia residents who self-reported having had venoplasty and consented to participate in the study were interviewed and followed for up to 24 months post-therapy using standardized structured questionnaires Results: Participants reported procedure-related complications (11.5%) and complications within the first month after the procedure (17.3%). Initially, more than 40% of participants perceived that the venoplasty had had positive effects on their health conditions, such as fatigue, numbness, balance, concentration/memory and mobility. However, this improvement was not maintained over time Conclusions: Follow-up patient-reported outcomes indicated that the initial perception of the positive impact of venoplasty on the health conditions of MS patients was not sustained over time. In addition, venoplasty was not without associated morbidity.

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42

Singh, AjayVikram. "Multiple sclerosis takes venous route: CCSVI and liberation therapy." Indian Journal of Medical Sciences 64, no. 7 (2010): 337. http://dx.doi.org/10.4103/0019-5359.99879.

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43

Ghezzi, A., G. Comi, and A. Federico. "Chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis." Neurological Sciences 32, no. 1 (December 15, 2010): 17–21. http://dx.doi.org/10.1007/s10072-010-0458-3.

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44

Rasminsky, Michael, and Karel terBrugge. "Goodbye to all that: a short history of CCSVI." Multiple Sclerosis Journal 19, no. 11 (September 23, 2013): 1425–27. http://dx.doi.org/10.1177/1352458513502400.

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45

Dolic, K., B. Weinstock-Guttman, K. Marr, V. Valnarov, E. Carl, J. Hagemeier, C. Brooks, C. Kilanowski, M. Ramanathan, and R. Zivadinov. "Risk Factors for Chronic Cerebrospinal Venous Insufficiency (CCSVI) (P05.127)." Neurology 78, Meeting Abstracts 1 (April 22, 2012): P05.127. http://dx.doi.org/10.1212/wnl.78.1_meetingabstracts.p05.127.

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46

Wang, X., and S. J. Sclafani. "Abstract No. 45: Optimizing azygous arch venography for CCSVI." Journal of Vascular and Interventional Radiology 23, no. 3 (March 2012): S22. http://dx.doi.org/10.1016/j.jvir.2011.12.081.

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47

Stone, Kathlyn. "Medical Device Conflict of Interest in the CCSVI Debate." Annals of Neurology 71, no. 3 (March 2012): A6—A8. http://dx.doi.org/10.1002/ana.23560.

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48

Brod, Staley A., Larry A. Kramer, Alan M. Cohen, Andrew D. Barreto, Thanh-Tung Bui, James R. Jemelka, Kelly Ton, et al. "Chronic cerebrospinal venous insufficiency: masked multimodal imaging assessment." Multiple Sclerosis Journal 19, no. 11 (July 4, 2013): 1499–507. http://dx.doi.org/10.1177/1352458513494493.

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Background: Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of multiple sclerosis (MS). Objective: We evaluated neurosonography (NS), magnetic resonance venography (MRV), and transluminal venography (TLV) in subsets of MS patients drawn from a single-center, prospective, case-control study of 206 MS and 70 non-MS volunteers. Methods: As previously reported, findings on high-resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vs 7.14%; p = 0.266). Ninety-nine MS participants consented to intravascular contrast-enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins. Results: NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties. Conclusions: Our findings lend no support for altered venous outflow dynamics as common among MS patients, nor do they likely contribute to the disease process.

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Simka, Marian. "COMMENTARY: Safety of Endovascular Treatment for CCSVI and Future Perspectives." Journal of Endovascular Therapy 18, no. 3 (June 2011): 326–27. http://dx.doi.org/10.1583/11-3400c2.1.

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Mayer, C. A., W. Pfeilschifter, M. W. Lorenz, M. Nedelmann, I. Bechmann, H. Steinmetz, and U. Ziemann. "The perfect crime? CCSVI not leaving a trace in MS." Journal of Neurology, Neurosurgery & Psychiatry 82, no. 4 (February 4, 2011): 436–40. http://dx.doi.org/10.1136/jnnp.2010.231613.

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Journal articles on the topic 'CCSVI'

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