title: Clinical improvement after extracranial venoplasty in multiple sclerosis.
abstract: OBJECTIVE
  This study proposed to prospectively evaluate safety and clinical changes in outpatient endovascular treatment in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI).
  
  
  METHODS
  Two hundred fifty-nine patients with MS were followed with the Multiple Sclerosis Impact Scale (MSIS-29) before and for 1 and 6 months after treatment of extracranial internal jugular vein and azygos vein stenoses and occlusions using venous angioplasty, as well as stent placement in 2.5% of patients. Before treatment, the patients were tested with magnetic resonance (MR) venography and flow quantification.
  
  
  RESULTS
  We found statistically significant improvements in the MSIS-29 scores (P < .01) at both 1 and 6 months. At 1 and 6 months, 67.9% and 53.6% were improved on the physical scale, respectively, and 53.0% and 44.4% were improved on the psychological scale, respectively. Women showed greater improvement than did men on the physical scale at 6 months (P = .01). Patients with primary progressive MS (PPMS) showed less improvement than did those with relapsing-remitting MS (RRMS) on the psychological scale at 1 month, and venoplasty treatment of more vein sites versus fewer vein sites showed greater improvement on the physical scale at both 1 and 6 months. Fifteen patients (6.3%) reported recurrent symptoms after clinical improvement and were treated again. There was one serious adverse event, a deep venous thrombosis at the catheter insertion site, which resolved with treatment.
  
  
  CONCLUSIONS
  Endovascular treatment of CCSVI in patients with MS appears to be a safe procedure resulting in significant clinical improvement.
authors.affiliation: Applied fMRI Institute, Hubbard Foundation, San Diego, California 92064, USA. davidhubbardmd@gmail.com
authors.forename: David
authors.initials: D
authors.lastname: Hubbard
authors.forename: Donald
authors.initials: D
authors.lastname: Ponec
authors.forename: Justin
authors.initials: J
authors.lastname: Gooding
authors.forename: Richard
authors.initials: R
authors.lastname: Saxon
authors.forename: Heidi
authors.initials: H
authors.lastname: Sauder
authors.forename: Mark
authors.initials: M
authors.lastname: Haacke
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001401:Azygos Vein; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000628:therapy*; D002908:Chronic Disease; D003251:Constriction, Pathologic; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000628:therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000628:therapy*; D010690:Phlebography / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D013116:Spinal Cord / Q000098:blood supply*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult