Chronic Cerebrospinal Venous Insufficiency In Multiple Sclerosis (CCSVI-MS) , Between The Phantom Hope Of Miraculous Endovascular Treatment And The Truth Of The Need For More Radical Treatment.

Abstract

Like breakthrough news of natural catastrophe, a radically different concept regarding the pathogenesis of multiple sclerosis (MS) has been proposed omitting the previous decades of research work in that field. Termed chronic cerebrospinal venous insufficiency (CCSVI), it suggests that macro occlusive abnormalities of the extracranial venous drainage pathways of the brain and spinal cord can cause or /and contribute to MS. Consequently, it has been suggested that angioplasty and possibly stenting of the internal jugular and/or azygos veins can improve the signs and symptoms of MS (Zamboni 2006; Zamboni, Menegatti et al. 2007). Since this breakthrough news a fierce pandemic has striked worldwide where these endovascular interventions have been performed sporadically across the globe in an open label fashion and never in the context of a well designed, controlled, randomized and blinded clinical trial. Despite this, this procedure 'liberation procedure' as it has been labeled by some ; sparkled a firestorm of interest in the medical and neurological communities, in both directions , to perform and not to perform. Each team has their rationale which is passionate at best, ranging from the myth that venous intervention is a miracle cure that must not be withheld from patients, to the feeling that the procedure is ineffective, unwarranted and dangerous at worst. The various views commonly see that those with differing beliefs are not acting in the best interest of the patients. As MS is a tuft practice of neurology, and neurointerventionalists interested in interventional treatment of neurological disorders are the neurology `s delivery man for neurointerventional procedures, we will attempt to analyze the available data and provide accordingly recommendations about whether or not endovascular treatment represents a reasonable option at this point of time for MS patients. To imagine the magnitude of a natural catastrophe, you should firstly bypass the denial phase to start counting the losses. So we will examine the source of the CCSVI theory and discuss the current data calling for or refuting its existence.