title: Safety of endovascular treatment of chronic cerebrospinal venous insufficiency: a report of 240 patients with multiple sclerosis.
abstract: OBJECTIVE
  To evaluate the safety of outpatient endovascular treatment in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI).
  
  
  METHODS
  A retrospective analysis was performed to assess complications occurring within 30 days of endovascular treatment of CCSVI. The study population comprised 240 patients; 257 procedures were performed over 8 months. The indication for treatment in all patients was symptomatic MS. Of the procedures, 49.0% (126 of 257) were performed in a hospital, and 51.0% (131 of 257) were performed in the office. Primary procedures accounted for 93.0% (239 of 257) of procedures, and repeat interventions accounted for 7% (18 of 257). For patients treated primarily, 87% (208 of 239) had angioplasty, and 11% (26 of 239) had stent placement; 5 patients were not treated. Of patients with restenosis, 50% (9 of 18) had angioplasty, and 50% (9 of 18) had stent placement.
  
  
  RESULTS
  After the procedure, all but three patients were discharged within 3 hours. Headache after the procedure was reported in 8.2% (21 of 257) of patients; headache persisted > 30 days in 1 patient. Neck pain was reported in 15.6% (40 of 257); 52.5% (21 of 40) of these patients underwent stent placement. Three patients experienced venous thrombosis requiring retreatment within 30 days. Sustained intraprocedural arrhythmias were observed in three patients, and two required hospital admission. One of these patients, who was being retreated for stent thrombosis, was hospitalized because of a stress-induced cardiomyopathy.
  
  
  CONCLUSIONS
  Endovascular treatment of CCSVI is a safe procedure; there is a 1.6% risk of major complications. Cardiac monitoring is essential to detect intraprocedural arrhythmias. Ultrasonography after the procedure is recommended to confirm venous patency and to identify patients experiencing acute venous thrombosis.
authors.affiliation: Department of Radiology, Albany Medical Center, MC-113, 47 New Scotland Avenue, Albany, NY 12208, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandato
authors.forename: Paul F
authors.initials: PF
authors.lastname: Hegener
authors.forename: Gary P
authors.initials: GP
authors.lastname: Siskin
authors.forename: Ziv J
authors.initials: ZJ
authors.lastname: Haskal
authors.forename: Meridith J
authors.initials: MJ
authors.lastname: Englander
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Garla
authors.forename: Nancy
authors.initials: N
authors.lastname: Mitchell
authors.forename: Laura
authors.initials: L
authors.lastname: Reutzel
authors.forename: Christopher
authors.initials: C
authors.lastname: Doti
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000601:surgery*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency; D014689:Venous Insufficiency / Q000209:etiology* / Q000601:surgery*