An overview of randomized controlled trials on endovascular treatment for chronic cerebrospinal venous insufficiency in multiple sclerosis patients

Abstract

About ten years ago it was hoped that venous angioplasty for abnormal veins, primarily the internal jugular veins, will be a much awaited treatment for multiple sclerosis. Yet, a majority of randomized clinical trials on endovascular treatment for chronic cerebrospinal venous insufficiency did not reveal clinical efficacy of these procedures in multiple sclerosis patients. Still, a detailed analysis of these trials suggests that they were poorly designed, underpowered and endovascular techniques used were often far from being optimal. Nonetheless, even considering weak points of these trials, it can be concluded that venous angioplasty should not be used as a routine treatment modality in multiple sclerosis patients. Still, a possibility that some patients may benefit from endovascular treatment cannot be ruled out. This may concern patients at early stage of the disease and presenting with lesions that can easily be managed with balloon angioplasty. Therefore, we need more studies evaluating clinical efficacy of venous angioplasty in selected subgroups of multiple sclerosis patients. Importantly, it has already been demonstrated that venous angioplasty in multiple sclerosis patients is a safe procedure. Thus, also from an ethical point of view, such trials seem justifiable.

Numerical modeling of blood flow in the internal jugular vein with the use of computational fluid mechanics software

“…In multiple sclerosis patients there were even attempts to normalize pathological outflows in the IJVs with the use of endovascular angioplasty, still with a limited success. 10,11 Better clinical outcomes, defined as significantly fewer new MRI lesions at 12 months after angioplasty, were found only in a subgroup of patients presenting with favourable vascular lesions, i.e. horizontal endoluminal defects with or without wall stenosis, and segmental stenosis with short endoluminal lesions.…”

Numerical Modeling of the Venous Outflow from the Cranial Cavity in the Supine Body Position

“…Interestingly, a decade ago, many multiple sclerosis patients were managed using endovascular angioplasty of their narrowed IJVs. Unfortunately, although early results of such a treatment were encouraging, positive outcomes in a long run were seen only in some subgroups of these patients [28][29][30]. Therefore, this treatment modality is no longer a standard one.…”

Numerical Modeling of Venous Outflow from the Cranial Cavity in the Supine Body Position

“…Interestingly, a decade ago, many multiple sclerosis patients were managed using endovascular angioplasty of their narrowed IJVs. Unfortunately, although early results of such a treatment were encouraging, positive outcomes in a long run were seen only in some subgroups of these patients [29][30][31]. Therefore, this treatment modality is no longer the standard one.…”