CCSVI
Exploring the Relationship:
Chronic Cerebrospinal Venous Insufficiency
& Multiple Sclerosis
James F. McGuckin, M.D.
Director, Philadelphia Vascular Institute
Founder, Vascular Access Centers
www.vascularaccesscenters.com
Introduction:
Dr. James McGuckin
Double major in Mechanical Engineering and Pre-Medical from the
University of Notre Dame in 1983, M.D. from Hahnemann University in 1987,
Masters Degree in Bioengineering at the University of Pennsylvania in 1990,
Diagnostic Imaging in 1995, and Fellowship in Interventional Radiology at the
Hospital of the University of Pennsylvania in 1996. Many invited lectures
annually in the USA and Internationally. Founded Philadelphia Vascular
Institute, Rex Medical, and Vascular Access Centers
(www.vascularaccesscenters.com). I am a full-time practicing Interventional
Radiologist and am licensed in over 20 states in the USA. I primarily see
Western Canadian citizens in Seattle and Eastern Canadians in Philadelphia
and New Jersey.
Research interests include: over 150 medical device patents, CCSVI,
Cardiovascular Systems, Endoscopy and Endosurgery, Peripheral Arterial
Disease, Limb Salvage, Percutaneous Oncologic Therapy, End Stage Renal
disease and recanalization of Central Venous Occlusion using RF ablation.
I have collaborated with Drs. Lindsay Machan (BC), C.S. HO (Toronto General)
and Dr. Sandy McDonald (Ontario) and I fully believe that the Canadian
physicians will be up to the clinical challenge of treating the patients with MS
from the vascular health perspective.
Autoimmune Theory
Commonly held beliefs about MS
 For more than fifty years, medical doctors and scientists have believed and adhered
to the theory that MS is an autoimmune disease.
 Autoimmune disease occurs when an overactive immune system—the system that
naturally protects the human body against disease—mistakenly attacks a healthy part
of the body as if it is a dangerous pathogen (like a virus) that must be destroyed.
 Proponents of the autoimmune theory believe that the disease develops when the
immune system mounts an aggressive, misguided attack against the myelin sheath that
insulates and protects the nerves of the Central Nervous System (CNS).
 They have yet to identify exactly why the immune system would initiate the attack.
 *Medicine changes and evolves- when I was in medical school Peptic Ulcer disease
was caused by acid not bacteria, Non-A Non-B Hepatitis became Hepatitis C, Breast
Cancer had an incidence of 1:11 later to become 1:7, and CABG (Coronary Artery
Bypass) was the mainstay- not the fall back plan if all else fails.
CCSVI – The Vascular Theory
How is the CCSVI theory different?
 The CCSVI theory as it relates to MS does not contradict the fact that there is
autoimmune activity and myelin damage within most MS lesions. It simply helps to
explain how and why this activity and damage got its start- and why the MS
symptoms follow similar patterns.
 According to the CCSVI theory, deformities in the veins that drain the CNS disrupt
proper outflow of deoxygenated blood from the brain and spinal column- this is why
we look for stenoses involving the drainage of the Jugulars, Azygous, Renal, and
Pelvis.
 These deformities include malformed valves,
membranous tissue or webbing inside the vein.
significant
narrowing,
and
 When the blood leaving the brain encounters these deformities, it often refluxes
back into the brain or stays too long within the brain because of delayed drainage.
“The Call” and The Hippocratic Oath
Can you open the blocked vein in my neck?
 The first patient- “can you open the blocked vein in my neck?” “I think I can open
your blocked vein, but I don’t know what it will do to your MS symptoms.” I was
naive.
 An amazing experience-five wheelchair bound patients getting out of the chair and
walking in our office in one week.
 The artist who could only see a circle on the wall- the circle that became a clock with
numbers and minute hash marks between the numbers while still on the procedure
table.
 The doctor speaks and nystagmus ceases. After three years of silence the physicianpatient with MS said his three children’s names and sang Happy Birthday to his wife.
His 10 years of constantly roving brainstem controlled eye movement stopped postprocedure and his eyes are now steady and controlled.
 Having a patient discharged from a nursing home and going home again- a joy to any
caregiver.
 A patient on the table saying-“I see colors again.” “The pain in my head is gone.”
 These treated deformities include malformed valves, significant narrowing, and
membranous tissue or webbing inside the vein.
Correlative Vascular Theory in Liver Cirrhosis
-Budd-Chiari Disease
 Vascular outflow obstruction
from the liver leads to portal
hypertension (localized high
venous blood pressure) causing
cirrhosis secondary to iron
deposition and inflammation.
This venous disease (narrowing)
is treated by venous angioplasty
and stenting if needed.
(Remember this picture you will
see it again.)
Prevalence of CCSVI
 “Many different groups from all over the world clearly showed by the means of
gold standard catheter venography that the prevalence of CCSVI in MS [patients] is
more than 90% of the cases studied (USA, Greece, Poland, Jordan, etc.)”
*International Society for Neurovascular Disease, Bologna 2010
Dr. McGuckin 2011 CCSVI QA Follow-Up Summary Averages
90%
82%
80%
68%
% of Positive Responses
70%
60%
50%
40%
30%
20%
10%
0%
McG CCSVI Follow-up respondents Avg
Previous symptoms resolved
Previous symptoms did not return
McG CCSVI Follow-up respondents Avg
68%
82%
Sample size (# of Respondents): 198
CCSVI QA Follow-up Summaries from Seattle, Atlanta, Houston, Downey, NOLA, DC,PG and Trenton
Treating CCSVI
What can be done today?
 The structural problems of CCSVI can
be treated effectively through balloon
venoplasty—angioplasty of the veins.
 Ballooning disrupts venous
irregularities by increasing the
diameter of the vein.
 Increased diameter leads to improved
blood flow, which helps reduce
venous insufficiency.
Catheter entry-point
FEMORAL
ACCESS VEIN
Access the patient easily through the Left Femoral vein with
ultrasound guidance.
TERNAL JUGULAR VEINS
AZYGOS SYSTEMS
CCSVI:
RENAL VEINS
ILIAC VEINS
RENAL VEINS
FEMORAL ACCESS
VEIN
-Extremelysafe
-Conscious sedation
-Rapid Recovery
-Checkandtreatthe
venousnarrowings
The Right Internal
Jugular is selected
and studied by
venogram- the
narrowing is
treated by
veno/balloon
angioplasty and
the collaterals or
side-street vessels
go away because
the resistance to
flow is gone
through valve
disruption.
Dramatic dilation by
balloon angioplasty
of the Left Internal
Jugular narrowing
with resolution of
the parallel vessels
showing the
resistant to flow by
the abnormal valve
being treated.
The picture on the left is the Left Internal Jugular vein againthe picture on the right is the Budd-Chiari venogram- upside
down. Venous narrowing look the same regardless of location.
14
The Azygous vein behind the heart with dramatic
congestion because of an outflow venous
narrowing treated successfully with angioplasty
47 yo MSx 17 yrs pre-CCSVI procedure
16
Secondary Progressive MS pre-CCSVI
17
24 hours post- procedure
18
4 days post-procedure
19
CCSVI – Summary
 I have personally studied hundreds of patients with MS. They all
have had CCSVI.
 The majority of these patients are citizens of Canada, and most of
them are enrolled in the Hubbard Registry.
 None of these MS patients were normal on venography and all had
truncal venous abnormalities. These deformities include
malformed valves, significant narrowing, and membranous tissue
or webbing inside the vein. Over 80% of patients have had a
positive response to the treatment with a reduction in their
symptoms.
 The focus of MS research should include discovering the etiology of
MS, improving treatments for MS patients, evaluating the safety
and efficacy of treating the vascular abnormalities associated with
CCSVI/MS, and developing therapies that augment and preserve
the improvements developed through endovascular treatment.