title: Venous Hemodynamic Insufficiency Severity Score variation after endovascular treatment of chronic cerebrospinal venous insufficiency.
abstract: BACKGROUND
  Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the internal jugular veins (IJVs) and/or azygos veins with disturbed flow and formation of collateral venous channels. The presence of CCSVI has been associated with multiple sclerosis (MS). Percutaneous venous angioplasty (PVA) has been proposed to improve extracranial outflow; however, a non-invasive, post-procedural follow-up outcome measure has not been established.
  
  
  OBJECTIVE
  To evaluate the short-term hemodynamic follow-up of CCSVI after PVA using color Doppler ultrasound (CDU) and to investigate whether hemodynamic variation correlated with clinical variation.
  
  
  METHODS
  Forty-five patients affected by MS with confirmed CCSVI underwent IJVs PVA. Venous hemodynamic (VH) parameters indicative of CCSVI and the Venous Hemodynamic Insufficiency Severity Score (VHISS) were evaluated by CDU at baseline and 3 months post-PVA. Concurrently, the MS-related disability status (EDSS) was evaluated.
  
  
  RESULTS
  The VH parameters and VHISS 3 months after IJVs PVA significantly decreased: the VH parameters -32.1% and the VHISS -33.8% (p < 0.001). The EDSS score 3 months after IJVs PVA was significantly lower than the baseline (-5.5%, p < 0.001). Using the median value of the VHISS variation as the cut-off, we were able to identify two groups of patients: responders, group A; and non-responders, group B. The EDSS score variation at 3 months was 0.310 in group A and 0.275 in group B (p = 0.746).
  
  
  CONCLUSIONS
  CCSVI endovascular treatment can induce an improvement in VH parameters and the VHISS. The neurological disability score (EDSS) also improved after PVA; however, there was no correlation to the VHISS variation after PVA, MS type and duration.
authors: Cardiac and Vascular Catheterization Laboratory, Policlinico di Monza, Monza, Italy CCSVI Research Center, Policlinico di Monza, Monza, Italy filippo.scalise@policlinicodimonza.it.
authors: Filippo
authors: F
authors: Scalise
authors: CCSVI Research Center, Policlinico di Monza, Monza, Italy Biostatistics Unit, Policlinico di Monza, Monza, Italy.
authors: Eugenio
authors: E
authors: Novelli
authors: CCSVI Research Center, Policlinico di Monza, Monza, Italy Vascular Surgery, Policlinico di Monza, Monza, Italy.
authors: Massimiliano
authors: M
authors: Farina
authors: CCSVI Research Center, Policlinico di Monza, Monza, Italy Cardiovascular Surgery Department, Policlinico di Monza, Monza, Italy.
authors: Luciano
authors: L
authors: Barbato
authors: CCSVI Research Center, Policlinico di Monza, Monza, Italy Cardiovascular Surgery Department, Policlinico di Monza, Monza, Italy.
authors: Salvatore
authors: S
authors: Spagnolo
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods; D001401:Azygos Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011446:Prospective Studies; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000098:blood supply; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014689:Venous Insufficiency / Q000503:physiopathology / Q000601:surgery*
keywords: CCSVI; color Doppler ultrasound; jugular veins; percutaneous venous angioplasty