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What went wrong? The flawed concept of cerebrospinal venous insufficiency

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Item Type:Review
Title:What went wrong? The flawed concept of cerebrospinal venous insufficiency
Creators Name:Valdueza, J.M. and Doepp, F. and Schreiber, S.J. and van Oosten, B.W. and Schmierer, K. and Paul, F. and Wattjes, M.P.
Abstract:In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research.
Keywords:Immunology, Magnetic Resonance, Multiple Sclerosis, Neurosonology, Ultrasound
Source:Journal of Cerebral Blood Flow and Metabolism
Publisher:Nature Publishing Group
Page Range:657-668
Date:May 2013
Official Publication:https://doi.org/10.1038/jcbfm.2013.31
PubMed:View item in PubMed

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