CCSVI Procedure for MS Patients

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CCSVI - chronic cerebrospinal venous insufficiency

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What is CCSVI?

CCSVI stands for Chronic Cerebrospinal Venous Insufficiency and has been a vital issue in scientific discussions over the last few years. Recently CCSVI was officially classified as belonging to a group of venous malformations (Congres Union Internationale de Phlebologie, Monte Carlo 2009), and has had its symptoms and methods of treatment described.

 

CCSVI consists of different pathologies: constrictions, stenosis, mostly located near internal cervical veins (vena jugularis interna) and the azygos vein (vena azygos).

 

What is MS?


Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by multifocal damage to the nervous tissue and the ever-changing course. There are periods of remission and exacerbations (relapses) with progressive loss of neurons and deterioration of the central nervous system tissue. Multiple sclerosis was first described by Jean-Martin Charcot in 1868. The incidence depends on the geographic region and ranges from 2 to 150 per 100 000 population in different countries and specific populations. MS affects mostly young adults, with peak incidence between 20 and 40 years of age. Women tend to get sick more often than men.


What is the relation between CCSVI and MS?


Hypotheses assuming the relationship between vascular abnormalities and MS have been known for many years:

  • 19th century, first observations – in 1863, Rindfleisch noted cumulation of blood vessels in the center of MS plaques and Charcot observed vascular blockages in MS patients
  • 1934 – T. Putnam suggested a major role of compromised venous drainage of the brain in forming MS lesions as well as inflammatory changes of the central nervous system
  • 1981 – F. A. Schelling proposed venous refluxes as one of the causes of MS

 

All those studies led to the introduction of endovascular procedures in MS patients – called Liberation Treatment, as first proposed by professor Zamboni in 2009.

Professor Zamboni launched a study to define whether there is a link between CCSVI and Multiple Sclerosis. With the use of Doppler ultrasound, he examined the necks of MS patients and according to data included in his publication, over 80% of patients with a RR (relapsing - remitting) type, more than 90% patients with a SP (secondary - progressive) type, and 90% patients with PP (primary - progressive) type meet the criteria for CCSVI diagnosis and liberation treatment (term proposed by prof. Zamboni). The majority of patients with MS evaluated by the team had stenosis, valve malformations and refluxes.

 

Drawing on previous experiences with standard coronary angiography procedures, in which balloons were used to restore patency of blocked coronary arteries, and with the cooperation of experienced vascular surgeon Dr Galeotti, they proposed venous angioplasty as a method of CCSVI treatment in MS patients.

 

Prof. Zamboni’s open labeled angioplasty study involved 65 participants and showed significant improvement in neurologic outcome and patients’ quality of life. It has opened doors for further research all over the world and the widespread use of endovascular treatment of CCSVI. The subject still remains open and even controversial, especially the theory that the venous pathology could constitute the primary patomechanism of the autoimmune process.


CCSVI Diagnostics

We perform a DOPPLER/ULTRASOUND examination, as well as MRV - Magnetic Resonance examination in order to establish the presence of CCSVI.

These examinations require the implementation of special diagnostic protocols and the use of high quality medical equipment possessing the appropriate diagnostic modules for vascular imaging in areas characteristic for CCSVI and Liberation Treatment.

 

We use „MyLabVinco" - Premium Echo Doppler Ultrasound System during the examinations. This is the only product designed specifically for the diagnosis of CCSVI available on the market.

 

CCSVI is a medical condition where deoxygenated blood flow from the veins surrounding the brain and spine is slowed or blocked in its return to the heart. This condition arises mainly from blockage in the internal jugular and/or azygos veins.

 

CCSVI, Chronic Cerebrospinal Venous Insufficiency, has been recognized recently, thanks to Italian scientist Dr. Zamboni in majority of MS patients.

TECHNICAL SPECIFICATIONS of the Doppler equipment used:


- Premium Echo Doppler Ultrasound System
- QDP Exclusive 3D Doppler Technology for multiple directional flow
- High sensitivity for Venous Low Flows
- CCSVI and VHISS (Venous Hemodynamic Insufficiency Severity Score) analysis, protocol and scoring system
- Dedicated measurements and reports

 

Venography

The final step in the CCSVI diagnostic process is a venography, which produces the most reliable diagnosis of abnormalities in the venous system. It consists of the administration of a contrast agent into the vein via a catheter (inserted in either the femoral or subclavian vein). This allows the most accurate visualization of vascular lesions. This procedure is invasive and therefore entails a risk of complications. Venography precedes any intra-vascular operations. The venography procedure allows for an exact examination and imaging of the venous system, which provides an excellent method of verifying and confirming the presence of any abnormalities detected by Doppler or MRV.

IVUS technology in CCSVI diagnostics and treatment in patients with MS

Intravascular ultrasound (IVUS) is a modern invasive method of diagnostic imaging. By using ultrasounds, IVUS allows more precise vessels anatomy imaging. The primary benefit of IVUS is that it offers a tomographic, 360-degree view of the vessel’s wall from the inside, allowing more complete and accurate assessment than it is possible with the use of venography examination.
Using IVUS in the diagnostics of Chronic Cerebrospinal Venous Insufficiency (CCSVI) allows more accurate assessment of venous pathologies (such as narrowings) and more precise selection of balloon catheters used in the venous angioplasty procedures. In the CCSVI treatment, AMEDS Centrum physicians use high-pressure balloons and cutting balloons.


CCSVI Treatment

There are two basic treatment methods, including inserting stents into a vascular system or applying balloon angioplasty which, according to Dr. Zamboni's theory, should stop or radically slow deterioration of the nervous system.

Angioplasty of the cervical venous system is performed using a local anesthetic. It is performed under x-ray control.

During the procedure, the patency (openness) of a treated vein is monitored by injecting the patient with a contrast medium, which allows for the level of the vein's constriction to be evaluated. Constriction of the jugular vein that impairs blood drainage from the brain can be expanded with a balloon catheter and/or stent.

 

The procedure starts at the femoral vein in the inguinal region. A slider is inserted behind the constriction through a special venal boot. A balloon catheter is then inserted through this guide. Inflation of this balloon causes widening of the venal constraint.

 

If balloon angioplasty does not expand the vein to an acceptable level, a stent – a steel frame that supports the venal walls - will instead be implemented.

 

To control the effectiveness of the procedure, a contrast medium is injected . The medium we use is of a coordinate valency type and therefore causes no major adverse effects.

 

After treatment patients will be asked to remain in a horizontal position for a minimum of 6 hours.

Please note:
Stents in our CCSVI clinic are inserted only when there is a direct indication present.


Post- treatment

Following successful CCSVI treatment patients will be required to take anti-coagulants on a daily basis. We also recommend a follow-up visit to our CCSVI clinic - AMEDS within six months of treatment to assess the condition of the veins that were subjected to treatment.

Risk related to angioplasty and stents

About 1- 2% of people who have a stented artery or vein develop a blood clot at the stent site. The risk of blood clots is greatest during the first few months after the stent is placed in the artery or vein. Doctors will likely recommend that patients take aspirin and other anti-platelet drugs, such as clopidogrel, for at least 1 month or up to one year or more after having a stent procedure performed. These medicines inhibit thrombus formation.

 

The length of time patients need to take anti-platelet medicine depends on the type of stent implanted. Doctors may recommend lifelong treatment with aspirin.

For more detailed information concerning the angioplasty procedure, please refer to this website: Angioplasty and Vascular Stenting.