“Some food for thought; a selection of abstracts on CCSVI from the ECTRIMS/ACTRIMS/LACTRIMS meeting in Amsterdam.”

P633: Haug et al. Intracranial venous pressure in MS is normal: ophthalmodynamometry data

Conclusions: Our data give no evidence however of an increase in intracranial venous pressure. Venous congestion in MS patients is implausible.

P631: Cavalla et al. CCSVI prevalence in a northern Italian population of MS patients and controls
Conclusions: In our population, CCSVI assessed by ECD appears to be more frequent in MS patients than in controls; however, CCSVI is found in more than one third of normal controls. These data are similar to those obtained with a similar protocol in a larger North American population. The issue of anomalous venous drainage in MS needs to be further clarified, also evaluating patients affected by other neurological diseases. The high frequency of CCSVI also in healthy controls suggests poor specificity of the current CCSVI criteria.

Conclusions: We found no evidence to suggest that MS patients have excess of CCSVI. In addition we failed to observe a typical venous flow pattern in MS patients. Until carefully designed controlled studies to investigate CCVSI have been completed, invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.

Conclusion: Doppler sonography is a suitable method for the investigation of IJV. We have not found any hemodynamically significant stenosis. No correlation was found between Tr and VF suggesting that reflux is not an indicator of venous insufficiency. Reflux was not observed in the proximal part but was observed in the distal part, where lumen area is substantially larger and venous valves are found, suggesting that the turbulence due to lumen dilation and valve movements is the real cause of the reflux. We have not found any significant difference in hemodynamics that might support the idea of CCSVI in MS patients. Based on these results catheter-dilatation does not seem to be a rational and acceptable approach in the treatment of MS.

P531:  Bonaventura et al. Femoral venous thrombosis and pulmonary massive embolism as a rare and major complication related to endovascular treatment of jugular veins in multiple sclerosis patient. 
Conclusion: This case should advice attention on this serious side effect, with venous deep thrombosis and pulmonary embolism, because in many cases patients have interventions in another far country and they need to travel long distances quickly in the post surgery. Regardless of the efficacy of these procedures in MS, we advise that it is necessary to consider and prevent this serious adverse event. 

Conclusions: This study shows that CCSVI is definitely not the cause of MS nor is it a late secondary phenomenon of MS, as it is not associated with disability. Therefore, there are no bases for “decongestant” procedures in MS patients. We strongly recommend extreme caution in interpreting an ultrasound-based diagnosis of CCSVI as absolute evidence of a pathological process involving the brain and the spinal cord, which in our opinion requires confirmation by VGF.

P1125: Burton et al. A systematic review of the association between chronic cerebral spinal venous insufficiency (CCSVI) and multiple sclerosis.
Conclusion: A meta-analysis of 8 studies found greater odds of CCSVI in MS patients compared to HC that was statistically significant, while such a relationship between CCSVI in MS patients vs. OND patients was not significant. However, limitations including uncertainty regarding blinding and its success and the marked heterogeneity of the results do not allow definitive conclusions to be reached. These early results raise the possibility that CCSVI may not be MS-specific, and it may follow, not precede the onset of disease. Further high quality controlled studies are needed to definitively determine if CCSVI is truly associated with MS. 

P1128: Dolic et al. Risk factors for chronic cerebrospinal venous insufficiency (CCSVI) in a large cohort of volunteers. 

Conclusions: Risk factors for CCSVI differ from established risk factors for peripheral venous diseases. Vascular, infectious and inflammatory factors were associated with higher CCSVI frequency.

P1105: Chambers et al. Chronic cerebrospinal venous insufficiency is not associated with clinically isolated syndrome or mild multiple sclerosis.
Conclusions: Our findings indicate that CCSVI, as defined by the Zamboni ultrasound criteria, is not seen in CIS and mild RRMS (EDSS <= 2), and provide further evidence that CCSVI does not have a causal role in the pathogenesis for the onset of MS.

P1104: Fox et al. Ultrasound assessment of chronic cerebrospinal venous insufficiency.
Conclusion: Initial pooled results found that 30% of subjects met criteria for CCSVI. A high proportion of subjects (45%) had valvular or intraluminal abnormalities on B-mode. Surprisingly, no subjects were found to have reverted postural control. Identification of deep cerebral vein reflux depended upon the ultrasound technique: QDP found reflux in half of subjects, but traditional Doppler found reflux in none. This observation highlights the importance of ultrasound methodology in performing and interpreting deep cerebral vein assessments. Ongoing studies will help clarify the potential relationship between CCSVI and MS.

P1108: Barreto et al. Prospective case-control study of CCSVI with imaging-blinded assessment: progress report focused on neurosonography.
Conclusion: At this stage, our studies suggest that NS findings described as CCSVI are much less prevalent than previously reported and do not distinguish MS from other subjects. We will now focus on whether NS can be complemented or supplanted by MRV and/or TV.

P134: Diaconu et al. Anatomical and histological analysis of venous structures associated with chronic cerebro-spinal venous insufficiency.  
Conclusion: Post mortem examination of the IJV and AZY veins of MS patients and non-MS controls demonstrated a variety of structural abnormalities and anatomic variations. Vein wall stenosis occurred at similar frequency in MS and non-MS controls. However, the frequency of intraluminal abnormalities with possible hemodynamic consequences was higher in MS patients compared to healthy controls, although the current sample size is limited. These results suggest that MRV (which predominantly evaluates vein wall stenoses) may be less effective than ultrasound in identifying venous abnormalities in CCSVI. In addition, examining only wall circumference in CCSVI ultrasound studies may miss some intraluminal abnormalities.

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