title: CCSVI and MS: no meaning, no fact.
abstract: A condition called "chronic cerebrospinal venous insufficiency" (CCSVI) has been postulated to play a role in the pathogenesis of multiple sclerosis (MS). This hypothesis implies that a complex pattern of extracranial venous stenosis determines a venous reflux into the brain of MS patients, followed by increased intravenous pressure, blood-brain barrier breakdown and iron deposition into the brain parenchyma, thus triggering a local inflammatory response. In this review, we critically analyze the scientific basis of CCSVI, the current literature on the relationship between CCSVI and MS, as well as the ultrasound methodology that has been claimed to provide evidence of impaired cerebral venous drainage. We show that no piece of the CCSVI theory has a solid supportive scientific evidence. The CCSVI appears to be a rather alien condition and its existence should be definitely questioned. Finally, no proven (i.e., based on strict scientific methodology and on the rules of evidence-based medicine) therapeutic effect of the "liberation" procedure (unblocking the extracranial venous obstruction using angioplasty) has been shown up to date.
authors.affiliation: Department of Neuroscience-SSPNRR, Stroke Unit, First Neurology Clinic, University of Padova, via Giustiniani, 5, 35128 Padua, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
authors.forename: Matteo
authors.initials: M
authors.lastname: Atzori
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
mesh_terms: D000818:Animals; D001921:Brain / Q000473:pathology; D004195:Disease Models, Animal; D004285:Dogs; D005337:Fibrin / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism; D009103:Multiple Sclerosis / Q000209:etiology*; D014689:Venous Insufficiency / Q000150:complications*
chemical_list: D005337:Fibrin; D007501:Iron