CCSVI and MS: no meaning, no fact

@article{Baracchini2012CCSVIAM,
  title={CCSVI and MS: no meaning, no fact},
  author={Claudio Baracchini and Matteo Atzori and Paolo Gallo},
  journal={Neurological Sciences},
  year={2012},
  volume={34},
  pages={269-279}
}
A condition called “chronic cerebrospinal venous insufficiency” (CCSVI) has been postulated to play a role in the pathogenesis of multiple sclerosis (MS). This hypothesis implies that a complex pattern of extracranial venous stenosis determines a venous reflux into the brain of MS patients, followed by increased intravenous pressure, blood–brain barrier breakdown and iron deposition into the brain parenchyma, thus triggering a local inflammatory response. In this review, we critically analyze… 
Extracranial Venous Drainage Pattern in Multiple Sclerosis and Healthy Controls: Application of the 2011 Diagnostic Criteria for Chronic Cerebrospinal Venous Insufficiency
TLDR
The hypothesis that CCSVI plays a primary role in the pathogenesis of MS is challenged as there was no statistically significant difference between MS patients and healthy controls regarding CCSvi prevalence.
Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis patients.
TLDR
There is currently no high level evidence to support or refute the efficacy or safety of percutaneous transluminal angioplasty for treatment of CCSVI in people with multiple sclerosis.
Evidence against the Involvement of Chronic Cerebrospinal Venous Abnormalities in Multiple Sclerosis. A Case-Control Study
TLDR
This case-control study provides compelling evidence against the involvement of CCSVI in multiple sclerosis.
Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases
TLDR
It is confirmed that at present endovascular treatment of CCSVI should not be recommended to patients with MS.
Potential involvement of the extracranial venous system in central nervous system disorders and aging
TLDR
The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.
Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases
TLDR
The findings confirm that at present ET should not be recommended to patients with MS and the risk of severe adverse events and the lack of objective beneficial effects are confirmed.
Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency in people with multiple sclerosis: a summary of a Cochrane systematic review
TLDR
There is currently no high level evidence to support or refute the efficacy or safety of percutaneous transluminal angioplasty for treatment of CCSVI in people with MS.
Hemoglobin as a source of iron overload in multiple sclerosis: does multiple sclerosis share risk factors with vascular disorders?
TLDR
This work proposes an additional way for understanding the neurodegenerative component of the disease caused by chronic subclinical extravasation of hemoglobin, in combination with multiple other factors including, but not limited to, dysfunction of different cellular protective mechanisms against extracellular hemoglobin reactivity and oxidative stress.
Funding CCSVI research is/was a waste of valuable time, money and intellectual energy: Yes
TLDR
The existence and the prevalence of CCSVI have been subsequently examined in many studies, with conflicting results: highly positive, some of them; weakly positive or totally negative in others.
The Evidence for Hypoperfusion as a Factor in Multiple Sclerosis Lesion Development
  • B. Juurlink
  • Medicine, Biology
    Multiple sclerosis international
  • 2013
TLDR
It is important that clinical trials addressing vascular issues in MS should examine how the vascular intervention affects white matter perfusion and determine whether the extent of perfusion recovery and maintenance of this recovery is related to functional recovery and Maintenance of functional recovery.
...
1
2
3
...

References

SHOWING 1-10 OF 106 REFERENCES
The perfect crime? CCSVI not leaving a trace in MS
TLDR
This triple-blinded extra- and transcranial duplex sonographic assessment of cervical and cerebral veins does not provide supportive evidence for the presence of CCSVI in MS patients, and cast serious doubt on the concept of C CSVI.
Cardiovascular and Interventional Radiological Society of Europe Commentary on the Treatment of Chronic Cerebrospinal Venous Insufficiency
TLDR
The basis for this new treatment rests on anecdotal evidence and successful testimonies by patients on the Internet, and CIRSE believes that this is not a sound basis on which to offer a new treatment, which could have possible procedure-related complications, to an often desperate patient population.
["Chronic cerebrospinal venous insufficiency" and multiple sclerosis: critical analysis and first observation in an unselected cohort of MS patients].
TLDR
The authors conclude that the "chronic cerebrospinal venous insufficiency (CCSVI)" cannot represent the exclusive pathogenetic factor in the pathogenesis of MS, and cannot justify invasive "therapeutic" approaches if they are performed outside of clinical trials.
Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency
TLDR
The findings indicate that CCSVI is not a late secondary phenomenon of MS and is not associated with disability.
Extracranial venous hemodynamics in multiple sclerosis
TLDR
The data argue against CCSVI as the underlying mechanism of MS, and potentially dangerous endovascular procedures, proposed as novel therapy for MS, should not be performed outside controlled clinical trials.
The chronic cerebrospinal venous insufficiency syndrome
TLDR
Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA), which determines a significant reduction of postoperative venous pressure.
Chronic cerebrospinal venous insufficiency in multiple sclerosis: clinical correlates from a multicentre study
TLDR
The strong associations between C CSVI and MS phenotype suggest that the presence of CCSVI may favour a later development of MS in patients with a lower susceptibility to autoimmune diseases and may increase its severity.
Complications in MS Patients after CCSVI Procedures Abroad (Calgary, AB)
  • J. Burton, K. Alikhani, M. Hill
  • Medicine
    Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
  • 2011
TLDR
As the debate about CCSVI and its relationship to MS continues, the complications and risks associated with venous stenting and angioplasty in jugular and azygous veins are becoming clearer.
Anomalous Venous Blood Flow and Iron Deposition in Multiple Sclerosis
  • A. V. Singh, P. Zamboni
  • Medicine, Psychology
    Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
  • 2009
TLDR
The hypothesis that iron deposits in MS are a consequence of altered cerebral venous return and chronic insufficient venous drainage is supported and several recently published studies support the hypothesis that MS progresses along the venous vasculature.
Venous drainage in multiple sclerosis
TLDR
The ECCS data contradict the postulated 100% prevalence of CCSVI criteria in MS and argue against a causal relationship of venous narrowing and MS, favoring the rejection of the CCS VI hypothesis.
...
1
2
3
4
5
...