Percutaneous venous angioplasty in patients with multiple sclerosis and chronic cerebrospinal venous insufficiency


Venous percutaneous transluminal angioplasty ( vPTA ) in patients with multiple sclerosis ( MS ) and chronic cerebrospinal venous insufficiency ( CCSVI ) have shown contradictory results.
The aim of the study was to evaluate the efficacy of the procedure in a randomized wait list control study.

66 adults with neurologist-confirmed diagnosis of multiple sclerosis and sonographic diagnosis of CCSVI were allocated into vPTA-yes group ( n = 31 ) or vPTA-not group ( n = 35, control group ).
Venous percutaneous transluminal angioplasty was performed immediately 15 days after randomization in the PTA-yes group and 6 months later in the control group.
Evoked potentials ( EPs ), clinical-functional measures ( CFMs ), and upper limb kinematic measures ( ULKMs ) were measured at baseline ( T0 ) and six months after in both groups, just before the venous angioplasty in the vPTA-not group ( T1 ).

Comparing the vPTA-yes and vPTA-not group, the CFM-derived composite functional outcome showed 11 ( 37% ) versus 7 ( 20% ) improved, 1 ( 3% ) versus 3 ( 8% ) stable, 0 versus 7 ( 20% ) worsened, and 19 ( 61% ) versus 18 ( 51% ) mixed patients ( χ2 = 8.71, df = 3, P = 0.03 ).

Unadjusted and adjusted ( for baseline confounding variables ) odds ratio ( OR ) at 95% confidence interval were, respectively, 1.93 ( 1.3-2.8 ), P value 0.0007, and 1.85 ( 1.2-1.7 ), P value 0.002.

EP- and ULKM-derived composite functional outcome showed no significant difference between the two groups.

In conclusion, venous angioplasty can positively impact a few clinical-functional measures especially for the quality of life but achieving disability improvement is unlikely. ( Xagena )

Napoli V et al, Ann Vasc Surg 2019; Epub ahead of print

XagenaMedicine_2019



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