Blood pressure normalization post-jugular venous balloon angioplasty

Abstract

ObjectiveThis study is the first in a series investigating the relationship between autonomic nervous system dysfunction and chronic cerebrospinal venous insufficiency in multiple sclerosis patients. We screened patients for the combined presence of the narrowing of the internal jugular veins and symptoms of autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping disorders, headache, thermal intolerance, bowel/bladder dysfunction) and determined systolic and diastolic blood pressure responses to balloon angioplasty.MethodsThe criteria for eligibility for balloon angioplasty intervention included ≥50% narrowing in one or both internal jugular veins, as determined by the magnetic resonance venography, and ≥3 clinical symptoms of autonomic nervous system dysfunction. Blood pressure was measured at baseline and post-balloon angioplasty.ResultsAmong patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction. Balloon angioplasty reduced the average systolic and diastolic blood pressure. However, blood pressure categorization showed a biphasic response to balloon angioplasty. The procedure increased blood pressure in multiple sclerosis patients who presented with baseline blood pressure within lower limits of normal ranges (systolic ≤105 mmHg, diastolic ≤70 mmHg) but decreased blood pressure in patients with baseline blood pressure above normal ranges (systolic ≥130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline blood pressure subcategories were observed.DiscussionThe coexistence of internal jugular veins narrowing and symptoms of autonomic nervous system dysfunction suggests that the two phenomena may be related. Balloon angioplasty corrects blood pressure deviation in multiple sclerosis patients undergoing internal jugular vein dilation. Further studies should investigate the association between blood pressure deviation and internal jugular veins narrowing, and whether blood pressure normalization affects Patient's clinical outcomes.

The Hemodynamics of Blood Flow through the Internal Jugular Veins after CCSVI Endovascular Treatment and its Impact on the Quality of Life in Patients with Chronic Cerebrospinal Venous Insufficiency

“…They showed that jugular vein angioplasty in patients with MS normalized the blood pressure. An increase in pressure was obtained in patients with low pressure (systolic ≤105 mmHg, diastolic ≤70 mmHg), while a decrease in this value was recorded in patients with pressure values above norm (systolic ≥130 mmHg, diastolic ≥80 mmHg) [27]. As might be expected, the beneficial hemodynamic effects of a vascular intervention should be translated into an improvement in the neurological condition of surgical patients.…”

Neuroendocrine Responses to Transvascular Autonomic Modulation: A Modified Balloon Angioplasty in Multiple Sclerosis Patients

“…These results suggest that BA has the potential for improving ANS dysfunction, often observed in MS patients [17,18]. In our clinical practice, 91 % patients who seek corrective BA present with a combination of internal jugular venous (IJVs) flow obstruction ( ≥ 50 % unilateral or bilateral IJV closure) and clinical symptoms such as cognitive impairment, fatigue, sleeping disorders, headache upon waking up, and thermal intolerance [14]. Cardiovascular ANS dysfunction is known to contribute to these clinical symptoms [19][20][21][22][23], suggesting a relationship between CCSVI and ANS dysfunction.…”

“…Furthermore, venous BA increases both the arterial and venous blood flow [12], correcting the hypoperfusion, which is the result of venous outflow obstructions [13]. Our recent study shows that BA has also the potential of correcting BP deviation in patients presenting with CCSVI [14]. The effect of BA on BP seems to be through the resetting of high pressure baroreceptors by sensing the degree of changes in central venous pressure; the latter is mediated via changes in volume [15].…”

Chronic Cerebrospinal Venous Insufficiency

“…1,2 In a recent review article, 3 our group presented strong evidence that the route of CCSVI might stem from cardiovascular autonomic system (ANS) dysfunction in general and sympathetic dysfunction in particular. ANS dysfunction could lead to dysregulation in the arterial blood pressure 4,5 and cerebral perfusion pressure, reducing cerebral blood flow. 6,7 The dysfunction of this system can also impair cerebral autoregulation, 8 reducing transmural pressure and increasing the critical closure pressure (CrCP).…”

“…11 The relationship between CCSVI and ANS dysfunction is further strengthened by the coexistence of CCSVI with clinical symptoms, such as cognitive impairment, fatigue, sleeping disorders, headache on awakening, and thermal intolerance. 5 Cardiovascular ANS dysfunction is known to contribute to these clinical entities. [12][13][14][15][16] Furthermore, the coexistence of CCSVI and cardiovascular ANS dysfunction has been reported in other autoimmune and neurological diseases.…”