Fixing the jugular flow reduces ventricle volume and improves brain perfusion

Zamboni, Paolo; Menegatti, Erica; Cittanti, Corrado; Sisini, Francesco; Gianesini, Sergio; Salvi, Fabrizio; Mascoli, Francesco

doi:10.1016/j.jvsv.2016.06.006

Cited by 31 publications

(37 citation statements)

References 43 publications

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“…In addition, flow improvement through the internal jugular veins owing to venous PTA has been reported to improve brain perfusion in patients with RRMS. 21 It has also been reported that the development of a new MS plaque was preceded by sustained MRI-detected hypoperfusion before the plaque was identified on MRI. 24,25 To our knowledge, few published data are available to compare with Brave Dreams findings.…”

Section: Discussionmentioning

confidence: 97%

“…19 Previous studies have reported that venous pressure is lowered 3 and cerebrospinal fluid dynamics is improved 20 after venous PTA, thereby favoring the drainage of cerebrospinal fluid into the dural veins, which depends on a pressure gradient between the subarachnoid spaces and dural veins. 21,22 Another study 23 reported that white matter lesion load was Abbreviations: NA, not applicable; PTA, percutaneous transluminal angioplasty. a All P values were >.99 after adjustment for multiplicity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial

Zamboni¹,

Tesio²,

Galimberti³

et al. 2018

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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; for the Brave Dreams Research Group IMPORTANCE Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. OBJECTIVE To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. DESIGN, SETTING, AND PARTICIPANTS We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6 MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. INTERVENTIONS Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). MAIN OUTCOMES AND MEASURES Two primary end points were assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. RESULTS Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7% vs 48.7%; odds ratio, 0.75; 95% CI, 0.34-1.68; P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95% CI, 0.15-0.91; P = .03: adjusted P = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95% CI, 0.32-1.63; P = .45; adjusted P = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95% CI, 1.11-6.28; P = .03; adjusted P = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95% CI, 0.81-4.01; P = .15; adjusted P = .30). CONCLUSION AND RELEVANCE Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS. TRIAL REGISTRATIO...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial

Zamboni¹,

Tesio²,

Galimberti³

et al. 2018

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…11 Similarly, a recent interventional study showed that by restoring the main drainage pathway, the collateral flow decreased from 70% to 30%. 12 More importantly, there was a 13-fold reduction in ventricular size associated with decrease of collateral flow lower than 20%. 12 Additionally, it was shown that the presence of venous abnormalities is associated with decreased perfusion in the gray matter (GM), the white matter (WM) and changes in cerebrospinal fluid dynamics.…”

Section: Introductionmentioning

confidence: 93%

“…12 More importantly, there was a 13-fold reduction in ventricular size associated with decrease of collateral flow lower than 20%. 12 Additionally, it was shown that the presence of venous abnormalities is associated with decreased perfusion in the gray matter (GM), the white matter (WM) and changes in cerebrospinal fluid dynamics. 13,14 Against this background, we hypothe- …”

Section: Introductionmentioning

confidence: 93%

Global and regional brain atrophy is associated with low or retrograde facial vein flow in multiple sclerosis

Jakimovski

Marr

Mancini

et al. 2017

Veins and Lymphatics

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Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler. Inflammatory MRI markers were assessed on a 3T MRI using a semi-automated edge detection and contouring/thresholding technique. MRI volumetric outcomes of whole brain (WB), gray matter (GM), white matter (WM), cortex, ventricular cerebrospinal fluid (vCSF), deep gray matter (DGM), thalamus, caudate nucleus (CN), putamen, globus pallidus (GP), and hippocampus were calculated. Independent t-test and ANCOVA, adjusted for age, were used to compare groups based on FV flow quartiles. Thirty-four MS patients with FV flow ≤327.8 mL/min (lowest quartile) had significantly lower WB (P<0.001), WM (P<0.001), thalamus (P=0.004), cortex (P=0.004), GM (P=0.004), DGM (P=0.008), hippocampus (P=0.005), and GP volumes (P=0.044) compared to 102 patients with FV flow of >327.8 mL/min (higher quartiles). There were no differences in T1-, T2-and gadolinium-enhancing lesion volumes between the quartile groups.The lack of an association between FV blood flow and inflammatory MRI measures in MS patients, but an association with brain atrophy, suggests that the severity of neurodegenerative process may be related to hemodynamic alterations. MS patients with more advanced global and regional brain atrophy showed low or retrograde FV volume flow.

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“…The doppler ultra sound (DUS) protocol, previously described [17,18] is aimed to assess respectively the brain inflow, the brain outflow, and the venous collateral flow index. The DUS assessment of the cerebral inflow consists in sampling the common carotid artery, the external and the internal carotid artery and the vertebral artery (VA).…”

Section: Dus Assessment Of Brain Haemodynamicsmentioning

confidence: 99%

The Eagle Jugular Syndrome

Zamboni

Scerrati

Menegatti

et al. 2019

Preprint

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Background: The elongation of the styloid process is historically associated with two variants of the Eagle syndrome. The classic one, mainly characterized by pain and dysphagia, and the carotid variant characterized by pain and sometimes by cerebral ischemia. We observed a further variant characterized by a styloid elongation coursing adjacent to the transverse process of C1, causing significant compression of the internal jugular vein. Methods : We reviewed all the cases of Eagle syndrome, including the jugular variant, admitted in our Hospital in the last six years. We compared symptomatology, associated comorbidities and imaging. Data were statistically analyzed. Results : Overall 23 patients were admitted to the Hospital for symptomatic elongation of the styloid process, 11 male and 12 females. The jugular variant of the Eagle syndrome is clinically delineated by significant differences, as compared to the classic variant and carotid variants. Headache was the more prominent symptom (p<.009) as well as a documented peri-mesencephalic hemorrhage was the more significant comorbidity (p<.0003). The group classic-carotid variant was characterized by ipsilateral pain respect to the jugular variant (p<.0003). CT angiography with venous phase extended to the neck veins and imaging reconstruction is highly recommended as imaging technique, complemented by color-Doppler ultrasound. Conclusions : The elongation of the styloid process may have different paths which creates compression on the surrounding anatomical structures. There may be a possible association of jugular impingement by an elongated styloid process with symptoms.

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Fixing the jugular flow reduces ventricle volume and improves brain perfusion

Cited by 31 publications

References 43 publications

Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial

Efficacy and Safety of Extracranial Vein Angioplasty in Multiple Sclerosis: A Randomized Clinical Trial

Global and regional brain atrophy is associated with low or retrograde facial vein flow in multiple sclerosis

The Eagle Jugular Syndrome

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