Special Communications
Interventional Endovascular Management of Chronic Cerebrospinal VenousInsufficiency in Patients with Multiple Sclerosis: A Position Statement by the Society of Interventional Radiology, Endorsed by the Canadian Interventional Radiology Association
IT has been recently hypothesized that a phenomenon known as chronic cerebrospinal venous insufficiency (CCSVI) may play a significant role in the etiology, pathogenesis, and/or disease progression of multiple sclerosis (MS) (1,2). Preliminary studies suggest that anatomical and physiological abnormalities of venous blood flow are significantly more common in patients with clinical MS than in healthy control subjects or patients with other neurologic disorders (3–6). Of particular interest has been the documentation of stenotic and occlusive lesions in the azygos and internal jugular
veins on duplex ultrasound and contrast venography of patients with clinical MS. One group (1,7,8) has reported improvement in clinical outcomes including quality of life in two small prospective uncontrolled cohorts of patients with MS in whom such lesions were treated with balloon angioplasty.
Although additional clinical studies have not yet been published, the potential for image-guided, catheter-based procedures to evolve into a standard treatment option for MS has engendered great interest and major controversy among interventional radiologists, vascular surgeons, neurologists, patients with MS, and their advocates.
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