CCSVI and Multiple Sclerosis
Multiple Sclerosis (MS) can be a devastating condition affecting young adults in their prime. There are various theories of causation of MS one of which is the Chronic Cerebrospinal Venous Insufficiency (CCVSI) theory proposed by Dr. Paolo Zamboni in Bologna, Italy. He has suggested that MS is due to underlying narrowing or obstruction to flow in the cerebral veins, jugular veins in the neck and vertebral and spinal veins running into the azygous veins.
The CCSVI theory of MS is contentious and although there is ongoing research in both Europe an North America showing an association between impaired venous flow and MS, causation has not been proven. Narrowing of the jugular veins can be treated by a balloon angioplasty treatment or stent placement if necessary (a treatment Prof. Zamboni has labelled the ‘liberation treatment’). Although early data and anecdotal patient experiences are promising the results of larger clinical trials will be required before the theory is more widely accepted by the medical community. There is as yet no conclusive scientific proof that ballooning or stenting a narrowed vein actually inproves outcomes in MS.
Dr. Crowe specialises in the scanning and minimally invasive treatments of vascular disease and has years of experience treating venous narrowings or stenoses due to other conditions such as cancer and dialysis related venous narrowings and occlusions. He is keeping a very open mind on the CCSVI theory and is liaising with other UK centres in setting up a CCSVI Vascular Assessment comprising a doppler ultrasound following Dr. Zamboni’s protocol and an MRI scan with MR Venography to assess the intracranial, central thoracic and azygous veins that are less readily visualised with doppler ultrasound.
There is a lack of consensus about the optimal combination of ultrasound and MRI / MRV scanning protocols and a requirement for a clear strategy plan for the next steps to be taken if a narrowing is found. Although the angioplasty or stent procedure is technically straightforward and could be undertaken by most vascular interventional radiologists, there are regulatory and ethical issues that must be satisfied before such a service can be implemented and CCSVI testing and treatment should ideally only be performed as part of an organised research project.
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New York Times article on CCSVI on June 29th 2010
Society of Interventional Radiology (SIR) issues position statement on CCSVI, September 2010
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