Multiple Sclerosis - A Vascular Etiology? (original) (raw)
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An Overview of Venous Abnormalities Related to the Development of Lesions in Multiple Sclerosis
2021
The etiology of multiple sclerosis (MS) is currently understood to be autoimmune. However, there is a long history and growing evidence for disrupted vasculature and flow within the disease pathology. A broad review of the literature related to vascular effects in MS revealed a suggestive role for abnormal flow in the medullary vein system. Evidence for venous involvement in multiple sclerosis dates back to the early pathological work by Charcot and Bourneville, in the mid-nineteenth century. Pioneering work by Adams in the 1980s demonstrated vasculitis within the walls of veins and venules proximal to active MS lesions. And more recently, magnetic resonance imaging (MRI) has been used to show manifestations of the central vein as a precursor to the development of new MS lesions, and high-resolution MRI using Ferumoxytol has been used to reveal the microvasculature that has previously only been demonstrated in cadaver brains. Both approaches may shed new light into the structural ch...
Internal Jugular Veins Outflow in Patients with Multiple Sclerosis: A Catheter Venography Study
Journal of Vascular and Interventional Radiology, 2013
To investigate an examiner-independent catheter venography protocol that could be used to reliably diagnose venous outflow abnormalities in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency and to determine whether venous angioplasty is effective in the treatment of these abnormalities. A total of 313 patients with MS and 12 patients with end-stage renal disease underwent echo-color Doppler sonography and catheter venography of the internal jugular veins (IJVs) to evaluate contrast medium clearance time. In patients with venous outflow anomalies, balloon angioplasty of the IJVs was performed. A contrast medium clearance time cutoff value of 4 seconds or less provided the maximal combination of sensitivity and specificity for the right IJV (sensitivity, 73.4%; specificity, 100%) and left IJV (sensitivity, 91.4%; specificity, 100%). IJVs with a clearance time between 4.1 and 6 seconds had moderate delayed flow (MDF), and IJVs with a clearance time longer than 6 seconds had severe delayed flow (SDF); 89% of patients showed MDF/SDF through at least one IJV, 79% showed MDF/SDF through both IJVs, and only 5% showed normal flow in both IJVs. Balloon angioplasty was immediately able to improve flow in at least one IJV in 69% of patients, but venous flow was normalized in both veins in only 37% of patients; SDF persisted after angioplasty in 32% of patients. There is a high prevalence of abnormal delayed flow through IJVs in patients with MS. Venous angioplasty was effective in only a minority of patients with SDF.
Journal of Vascular Surgery, 2010
Objectives: The aim of this report is to assess the safety of endovascular treatment for chronic cerebrospinal venous insufficiency (CCSVI). Although balloon angioplasty and stenting seem to be safe procedures, there are currently no data on the treatment of a large group of patients with this vascular pathology. Methods: A total of 564 endovascular procedures (balloon angioplasty or, if this procedure failed, stenting) were performed during 344 interventions in 331 CCSVI patients with associated multiple sclerosis. Results: Balloon angioplasty alone was performed in 192 cases (55.8%), whereas the stenting of at least one vein was required in the remaining 152 cases (44.2%). There were no major complications (severe bleeding, venous thrombosis, stent migration or injury to the nerves) related to the procedure, except for thrombotic occlusion of the stent in two cases (1.2% of stenting procedures) and surgical opening of femoral vein to remove angioplastic balloon in one case (0.3% of procedures). Minor complications included occasional technical problems (2.4% of procedures): difficulty removing the angioplastic balloon or problems with proper placement of stent, and other medical events (2.1% of procedures): local bleeding from the groin, minor gastrointestinal bleeding or cardiac arrhythmia. Conclusions: The procedures appeared to be safe and well tolerated by the patients, regardless of the actual impact of the endovascular treatments for venous pathology on the clinical course of multiple sclerosis, which warrants long-term follow-up.
Chronic cerebrospinal venous insufficiency and multiple sclerosis
Annals of Neurology, 2010
A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular balloon angioplasty or venous stent placement has been proposed as well as conducted in small patient series. In some cases, it may have resulted in serious injury. In this Point of View, we discuss the recent investigations that led to the description of CCSVI as well as the conceptual and technical shortcomings that challenge the potential relationship of this phenomenon to MS. The need for conducting carefully designed and rigorously controlled studies to investigate CCVSI has been recognized by the scientific bodies engaged in MS research. Several scientific endeavors examining the presence of CCSVI in MS are being undertaken. At present, invasive and potentially dangerous endovascular procedures as therapy for patients with MS should be discouraged until such studies have been completed, analyzed, and debated in the scientific arena. ANN NEUROL 2010;67:286 -290 R ecently, the topic of chronic cerebrospinal venous insufficiency (CCSVI) and its potential relationship to multiple sclerosis (MS) has generated tremendous interest in the news media, spilling over to the patient and scientific communities. Described as a state of chronic impaired venous drainage from the central nervous system (CNS), the emergence of CCSVI with respect to MS is based on the work done by Zamboni and colleagues. 1 This was followed by a small open-label study conducted to study the effect of endovascular angioplasty in MS patients with CCSVI. 2 Prompted by this series of events, this Point of View will review available information on CCSVI, its potential relationship to MS pathology, and what further research needs to be undertaken while keeping patient safety foremost.
Perspectives in Medicine, 2012
Because of the recent hypothesis of involvement of the venous hemodynamics in multiple sclerosis (MS), and because of the pitfalls of these studies, there is the need to achieve a definite conclusion from a large sample of subjects by using a strict and controlled neurosonological protocol. The aim of the advanced protocol, designed for a subgroup of the FISM study, is to analyze several items of the venous hemodynamics in order to obtain more pathophysiological data on venous circulation. Advanced Ultrasound Protocol: This is a multicenter, observational study. From a pool of about 1200 adults with MS, 400 healthy subjects and 400 subjects with other neurodegenerative disorders (2000 subjects in total) will be selected a population able to be examined by the advanced protocol. The examiner will always be blind on the clinical diagnosis, and the exams will be performed according to a standard protocol, whose measurements are mandatory for all participating centers. The advanced protocol is on a voluntary basis and it is optional. It includes, besides the basic one, measurements of blood flow volumes in carotid and vertebral arteries and in jugular and vertebral veins (inflow and outflow), with the definition of the drainage pattern. The ultrasound examination at each clinical site will
Polish journal of radiology / Polish Medical Society of Radiology, 2011
Multiple sclerosis (MS) is a chronic disease with not well understood etiology. Recently, a possible association of MS with compromised venous outflow from the brain and spinal cord has been studied (chronic cerebrospinal venous insufficiency - CCSVI). Angioplasties of internal jugular veins (IJV) and azygous vein (AV) have given promising results, with improvements in patients' clinical status. 830 patients with clinically defined MS were scanned from the level of sigmoid sinuses to the junction with brachiocephalic veins, as well as at the level of AV. T2-weighted, 2D TOF and FIESTA sequences were used. The examination revealed a slower blood flow in IJVs, in 98% of patients: on the right side - in 6%, on the left side - in 15%, on both sides with right-side predominance - in 22%, on both sides with left-side predominance - in 34%, bilaterally with no side predominance - in 19%. In 2%, there was a slower blood flow in IJVs, vertebral veins and subclavian veins and also in the ...