Chronic cerebro-spinal venous insufficiency (CCVI)Thursday, October 11, 2012, 15:30 - 17:00
Cine cerebrospinal fluid imaging changes in patients with multiple sclerosis after venous angioplasty. A 1-year follow-up studyR. Zivadinov, C. Magnano, R. Galeotti, C. Schirda, B. Weinstock-Guttman, E. Menegatti, J. Hagemeier, A.M. Malagoni, D. Hojnacki, C. Kennedy, I. Bartolomei, C. Beggs, F. Salvi, P. Zamboni (Buffalo, US; Ferrara, IT; Bologna, IT; Bradford, GB)
Background: Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). Percutaneous transluminal angioplasty (PTA) of duplex-detected lesions (in the internal jugular and/or azygos veins) was previously applied in a pilot study of 15 MS patients to preliminarily assess whether PTA reduced MS disease activity, when used in addition to standard medical treatment. The higher percent brain volume change decrease over the first 6 months (-1.27%) in the immediate treatment group (ITG) suggested a more pronounced pseudoatrophy effect compared with the delayed treatment group (DTG) (-0.57%), possibly because of a potential anti-inflammatory effect of PTA or alternatively, due to a decrease in brain volume or improvement in cerebrospinal fluid (CSF) flow because of better venous drainage following angioplasty.
Objectives: To investigate changes in cine cerebrospinal fluid (CSF) pulsatile flow and velocity measures in patients with relapsing-remitting (RR) MS who underwent venous angioplasty.
Methods: This was a prospective cohort study, that included 15 patients with RRMS and duplex-detected CCSVI. Eight patients had PTA in addition to medical therapy (ITG) immediately following baseline assessments, while 7 had delayed treatment with PTA after 6 months of medical therapy alone (DTG). CSF pulsatile flow and velocity measures were quantified over 32 phases of the cardiac cycle, using a semi-automated method. These outcomes were compared between ITG and DTG at baseline, 6 and 12 months of the study.
Results: At baseline, there were no significant differences between ITG and DTG in CSF pulsatile flow (p=0.474) or velocity (p=0.714) measures. However at month 6, significant improvement in CSF pulsatile flow (p<0.001) and velocity (p=0.013) was detected in the ITG compared to DTG. This difference persisted at month 12 of the study for CSF pulsatile flow (p=0.001) and velocity (p=0.021) between the two groups. Within-group changes showed significant improvement in CSF pulsatile flow over 12 months in both ITG (p=0.033) and DTG (p=0.024). No significant within-group changes were found for velocity in both treatment arms.
Conclusions: This study shows that in MS patients with CCSVI, PTA treatment has a beneficial effect on CSF flow and velocity measures. This improvement could be due to better venous drainage following angioplasty.
Christopher Magnano, Roberto Galeotti, Erica Menegatti, Jesper Hagemeier, Anna Maria Malagoni, David Hojnacki, Cheryl Kennedy, Ilaria Bartolomei and Clive Beggs have nothing to disclose.
Robert Zivadinov received personal compensation from Teva Neuroscience, Biogen Idec, EMD Serono and Questcor Pharmaceuticals for speaking and consultant fees. Dr. Zivadinov received financial support for research activities from Biogen Idec, Teva Neuroscience, Genzyme, Bracco, Questcor Pharmaceuticals and EMD Serono.
Bianca Weinstock-Guttman received personal compensation for consulting, speaking and serving on a scientific advisory board for Biogen Idec, Teva Neuroscience and EMD Serono. Dr. Weinstock-Guttman also received financial support for research activities from NMSS, NIH, ITN, Teva Neuroscience, Biogen Idec, EMD Serono, and Aspreva.
David Hojnacki has received speaker honoraria and consultant fees from Biogen Idec, Teva Pharmaceutical Industries Ltd. and EMD Serono, Pfizer Inc.
Fabrizio Salvi received funds for the present study from the Hilarescere Foundation.
Paolo Zamboni received funds for the present study from the Hilarescere Foundation.