Chronic cerebrospinal venous insufficiency and multiple sclerosis.
A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular balloon angioplasty or venous stent placement has been proposed as well as conducted in small patient series. In some cases, it may have resulted in serious injury. In this Point of View, we discuss the recent investigations that led to the description of CCSVI as well as the conceptual and technical shortcomings that challenge the potential relationship of this phenomenon to MS. The need for conducting carefully designed and rigorously controlled studies to investigate CCVSI has been recognized by the scientific bodies engaged in MS research. Several scientific endeavors examining the presence of CCSVI in MS are being undertaken. At present, invasive and potentially dangerous endovascular procedures as therapy for patients with MS should be discouraged until such studies have been completed, analyzed, and debated in the scientific arena.
Khan
Omar
O
Multiple Sclerosis Center, Department of Neurology, Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48323, USA. okhan@med.wayne.edu
Filippi
Massimo
M
Freedman
Mark S
MS
Barkhof
Frederik
F
Dore-Duffy
Paula
P
Lassmann
Hans
H
Trapp
Bruce
B
Bar-Or
Amit
A
Zak
Imad
I
Siegel
Marilyn J
MJ
Lisak
Robert
R
D017130:Angioplasty / Q000009:adverse effects / Q000379:methods / Q000592:standards; D001401:Azygos Vein / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002406:Catheterization, Peripheral / Q000379:methods / Q000706:statistics & numerical data; D015984:Causality; D002490:Central Nervous System / Q000098:blood supply / Q000503:physiopathology; D002550:Cerebral Veins / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy; D006801:Humans; D007601:Jugular Veins / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D009103:Multiple Sclerosis / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012008:Recurrence; D018570:Risk Assessment; D013116:Spinal Cord / Q000098:blood supply / Q000503:physiopathology; D020760:Spinal Cord Ischemia / Q000209:etiology / Q000503:physiopathology; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy