Friday, 21 December 2012

Complications from CCSVI

#MSBlog: complications from jugular vein stenting in MS

Dole┼żal et al. Serious Complication of Percutaneous Angioplasty with Stent Implantation in so Called "Chronic Cerebrospinal Venous Insufficiency" in Multiple Sclerosis Patient. Prague Med Rep. 2012;113:289-93.

This group report a female MSer, age 51, diagnosed with MS in 1998, who underwent two venoplasty procedures with stent implantation for CCSVI in 2010. Expanded disability status scale (EDSS) worsened after the procedure was performed from 4.5 to 6. A total number of three stents were implanted (two of them in the right internal jugular vein). In 2011, 6 months after the first procedure, the MSer was referred for independent examination by computer tomography (CT) phlebography for right-sided neck pain. Dislocation of stents were noted on the right side and the left-sided stent was thrombosed. A conservative approach was used to treat this complication. This short report demonstrates the possible complications of venoplasty and stenting of the jugular veins in CCSVI and demonstrates that the neurological state (EDSS) worsened in this subject despite the procedure. Continued migration of the stents is possible in the future with an associated risk of pulmonary embolism, which can have a fatal outcome. These neurologists recommend that angioplasty procedures be restricted for the treatment of CCSVI as it has not been proven to be relevant entity in MS.

A clotted or thrombosed jugular vein.

"Is it ethical to refer MSers to have angioplasty and stenting for a condition that may not exist or has no evidence to support its benefit in MS? My opinion remains the static; all procedures need to be done under well-designed and controlled trial conditions with informed consent. Nobody should be paying for this procedure until it has been shown to work; i.e. we need class 1 evidence."