Saturday, 25 June 2011

Is the treatment of CCSVI safe?

Petrov et al. Safety profile of endovascular treatment for chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Endovasc Ther. 2011 Jun;18(3):314-23.

The purpose of this study was to evaluate the safety of endovascular treatment of chronic cerebrovascular insufficiency (CCSVI) in patients with MS. In a 1-year period 461 MS'ers underwent endovascular treatment of 1012 venous lesions during 495 procedures. Although balloon angioplasty was preferred, 98 stents were implanted in 76 patients for lesion recoil, restenosis, or suboptimal dilation. There were no deaths, major bleeding events, or clinical deterioration of MS. Complications at the site of venous access included limited groin hematoma (5, 1.0%); there were no arteriovenous fistulas or puncture site infections. Systemic complications included cardiac arrhythmias (6, 1.2%). Procedure-related complications included vein rupture (2, 0.4%), vein dissection (15, 3.0%), acute in-stent/in-segment thrombosis (8, 1.6%), and acute recoil (1, 0.2%); there was no stent migration or fracture or distal embolization. The average x-ray or fluoroscopy time was 22.7 minutes, and mean contrast volume used was 136.3 mL. The investigators concludes that endovascular therapy appears to be a safe and reliable method for treating CCSVI. 

"Do you think it is safe?"

"I am amazed that so many patients are undergoing this procedure; particularly when CCSVI has yet to be established as a disease entity or cause of MS and that endovascular treatment has yet to be shown to work in appropriately designed randomised controlled trials."

CoI: nil

6 comments:

  1. I don't think you should be amazed at the number of people undergoing this treatment. People hear of incidents where people feel that their symptoms have improved after the treatment and so they think 'what have I go to lose?' and go for the treatment themselves. I have been told of one such person locally, by someone who I believe to be objective. I'm not planning to go for treatment but I can see the attraction. As you have said in previous posts, some (many?) people really are pretty desperate to find something that will help.

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  2. Prof G,

    My view is this is a fad which will diminish over time.

    Regarding the reason patients are undergoing this operation is simple - neurology has failed them. There are no treatments for progressive MS and many of your posts refer to massive unmet needs in relation to many of the symptoms of this disease. When a neuro sends patient on their way with a "sorry can't help...see you in a year", patients will look elsewhere and try anything.

    When neurology can offer treatments for progressive MS and symptomatic treatments which are very effective, CCSVI will fall away quickly.

    Note: it looks as if these posts are targetted at you, but I'm talking about neurology as a specialism (not your concerted efforts).

    Did you attend MS Frontiers? Any positive news?

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  3. Yes, wholeheartedly agree with the Note above - posts are not targeted at you - except the complimentary ones, of course!

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  4. There is nothing 'irrational' or ‘desperate’ about undergoing for venoplasty for impaired venous drainage. I have seen my venogram images and I did have the venous problems Zamboni has described in both my jugular veins and also my azygos vein. When contrast medium was added, the blockage of downward flow in my jugular vein was obvious, as was the reflux of blood back up the vein.

    Also I’ve had no medical complications, just a vastly improved quality of life.

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  5. Anon 9:33
    Post was spammed it went like this, I have removed names i.e adverts.

    Spammed mail either is post as is deleted thats how the blogger software works.

    I have done the procedure and I must admit it is very useful. I have done it in Italy......and what an improvement! My life is back. Would encourage every body to do so.....my 2 cents.

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  6. Re: "I have done the procedure and I must admit it is very useful. I have done it in Italy......and what an improvement! My life is back. Would encourage every body to do so.....my 2 cents."

    We can't practice neurology on anecdotes. Show me the evidence. Anecdotes are simply their to help formulate new hypotheses so as to do new trials.

    ReplyDelete

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