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Bavera P. M. 1, Agus G. B. 2, Alpini D. 3, Cecconi P. 4, Guazzoni A. 5, Tori A. 6, Costantini E. 6, Lupattelli T. 7
1 Medick-Up Vascular Surgery and Angiology Lab, Milan, Italy;
2 Unit of Vascular Surgery and Angiology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;
3 ENT-Otoneurology Service, Fondazione Don Carlo Gnocchi, Milan, Italy;
4 Radiology and Neuroradiology Imaging Service, Fondazione Don Carlo Gnocchi, Milan, Italy;
5 Department of Diagnostic and Interventional Radiology, San Biagio Hospital, Domodossola,Italy;
6 Vascular Surgery and Endovascular Unit, Busto Arsizio Hospital, Italy;
7 Interventional Radiology Unit, Salus Hospital, Reggio Emilia, Italy
Aim. Ultrasound (US) diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) and its association with MS is highly controversial, perhaps for lack of both training and awareness of what is normal in cervical veins mainly because they are not segments usually investigated in Vascular Labs.
Methods. The work is based upon the results of 823 consecutive Duplex (DU) exams carried out in one year on Multiple Sclerosis (MS) patients. The purpose was to eventually detect and quantify the presence of CCSVI and possible benefits on PTA-treated patients, according to the Zamboni criteria protocol. The authors scanned first a consecutive group of 60 controls, not affected by MS, aged 28-62 years old, in order to improve the personal learning curve in investigating the cervical veins. Therefore they investigated 696 MS patients and 127 MS patients post-PTA treatment for diagnosed CCSVI.
Results. Within the 60 controls, only 3 (5%) showed one flow abnormality according to the Zamboni criteria, considered insufficient for CCSVI diagnosis, while in the remaining 57 (95%) they were totally absent. In the 823 patients affected by MS, 627 (90%) matched with sufficient Zamboni criteria scores. The frequency of CCSVI among MS patients and non-MS controls revealed a higher CCSVI prevalence in the MS group (odds ratio 576.7; 95% confidence interval 286.2-1161.9; χ2=310 and P-value<0.0001). Finally, 88 patients (69%) of the post procedural Duplex examination were negative for CCSVI Zamboni criteria and this result was associated to symptoms improvements. Other previous, but smaller studies, were previously carried out with the aim to investigate CCSVI in MS and the lack of detection in this particular population of patients may be subsequent to insufficient training and completion of an adequate learning curve.
Conclusion. The present study demonstrates in a large survey, the strong association between the two conditions. In addition, PTA may revert abnormal duplex haemodynamics in a large proportion of patients.