Angioplasty for MS requires more research
Using angioplasty to widen the jugular and azygos veins to improve blood flow to the brain could help prevent multiple sclerosis (MS) in patients with chronic cerebrospinal venous insufficiency, according to the Society for Interventional Radiology (SIR). However, a multicenter trial is critical to understanding the condition and its possible treatment, the society noted.

“Much work needs to be done to better define, explore and prove the concept of vein obstruction playing a role in causing multiple sclerosis,” said Gary P. Siskin, MD, a SIR research consensus panel member.

Blockage in veins that drain blood from the brain and spinal cord and return it to the heart might contribute to MS and its symptoms, according to Siskin, an interventional radiologist and chair of the radiology department at Albany Medical Center in N.Y. The impact of widening those veins with angioplasty to reduce the severity of MS needs to be studied, he noted.

“This is an entirely new approach to the treatment of patients with neurologic conditions, such as MS, and could be transformative for patients,” Siskin noted. “Continued investigation is needed in this area. Researchers are clearly very early in this understanding of both the condition and the treatment.”

About 500,000 people in the U.S. have MS, according to a press release from SIR, and the condition is currently treated with disease-modifying drugs which “modulate or suppress the immune response believed to be central in the progression of the disease, and these drugs carry significant risk.”

“The idea that there may be a venous component that causes some symptoms in patients with MS is a radical departure from current medical thinking. There is a healthy level of skepticism in both the neurology and interventional radiology communities about the condition, the treatment and the outcomes,” said Gordon McLennan, MD, an interventional radiologist with the Cleveland Clinic.

Siskin noted that the internet has given rise to popularity for the treatment. “Individuals are discussing it among themselves—through blogs and social networking sites—and then turning to interventional radiologists for this minimally invasive treatment,” he said. The Journal of Vascular and Interventional Radiology noted that individuals are seeking treatment for CCSVI despite limited available scientific evidence.

Many physicians are currently offering endovascular therapy for MS patients who feel they cannot wait until definitive studies are completed, SIR noted, and these treatments “are provided with the hope of helping MS patients who suffer from intractable symptoms, but it is hoped that this work will also provide insights that improve the design of peer-reviewed studies that clarify the role in MS of treating venous disease with angioplasty, according to 'Development of a Research Agenda for Evaluation of Interventional Therapies for Chronic Cerebrospinal Venous Insufficiency: Proceedings from a Multidisciplinary Research Consensus Panel.'

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