STUDY OF THE CHRONIC CEREBRO-SPINAL VENOUS INSUFFICIENCY IN A POPULATION OF
YOUNG PEOPLE WITH MULTIPLE SCLEROSIS BY HEMODYNAMIC MAP MORPHOLOGICAL
S. MANDOLESI; F. L. CICIARELLO; F. FEDELE; L. AGATI, A. MARCECA; UNIVERSITY SAPIENZA , DEPARTMENT OF CARDIOVASCULAR DESEASE , ROME, ITALY
72° SIC CONGRESS, 10-12 December 2011
BACKGROUND: Multiple Sclerosis (MS) is the most common autoimmune neurological disorder in young adults. There are several different clinical types: Relapsing Remitting-MS (RR);
Secondary Progressive –MS (SP); Primary Progressive –MS (PP). Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) is a new vascular pattern recently identified by Zamboni, who
associated CCSVI with MS.
AIM: we analyzed the presence of CCSVI in a young population with less than 30 years old affected by MS, following Zamboni’s five ultrasound criteria and using an
Hemodynamic Map Morphological (HMM), versus a large sample of adult patients with MS and more than 30 years old.
MATERIALS AND METHOD: we included in this study 668 patients affected by MS (all clinical types) . We divided them in 194 young patients: CCSVI positive 75,3 % (n=146) and
CCSVI negative 24,7 % (n=48); 474 adult patients: CCSVI positive 85,7 % (n=406) and CCSVI negative 14,3 % (n=68). We studied only CCSVI positive population : 146 young patients
CCSVI positive (GROUP 1), mean duration disease <5 years (women 58,9%, n=86; men 41,1%, n=60; mean age 25 years; mean Expanded Disability Disease Score, EDSS 3); adult
patients (GROUP 2) was composed of 406 CCSVI and mean duration disease >5 years (women 60,8%, n=247; men 39,2%, n=159; mean age 47 years; mean EDSS 5). We investigated the
population by means of high resolution B-mode ultrasounds (MyLab Vinco ECD System, equipped with 2.5 and 7.5-10 Mhz probes) and hemodynamic according to Zamboni’s criterion to
diagnose
the CCSVI:
.
1-Reflux in the Internal Jugular Veins (IJVs) and/or Vertebral Veins (VVs); 2-Reflux in the Internal cerebral veins (DCVs); 3 -High-resolution B-mode-evidence of proximal IJV stenosis
(Morphological and Hemodynamic stenosis); 4-Flow not Doppler detectable in the IJVs and/or VVs (block intra-venous); 5-Reverted postural control of the main cerebral venous outflow
pathway, investigating in both positions (0°and 90°). The ECD examinations were then reported on Hemodynamic Map Morphological (HMM), it’s a new digital computerized software,
created in our school, where the operator inserts symbols that correspond to the five Zamboni criteria.
BASELINE CCSVI pos
YOUNG(<30 years old)
GROUP 1
( n= 146)
RR-MS 76,7%
(n=112 )
SP-MS 15%
(n= 22)
PP-MS 8,3%
(n=12)
30,6
30,3
31,9
30,3
MALE
41,1%
41,1 %
45,5%
33,3%
FEMALE
58,9 %
58,9%
54,5%
66,7%
AGE (mean)
EDSS (mean)
DURATION(mean)
3
3,1
4,2
4
5,1
5,2
4,7
4,6
BASEL INE CCVSI pos
ADULT(>30 years old)
GROUP 2
(n=406)
RR-MS 62,3 %
(n=253)
SP-MS 26,6%
(n= 108)
PP-MS 11,1%
(n=45)
47
46
49,6
50
MALE
39,2%
38,3 %
39,8 %
42,2 %
FEMALE
60,8 %
61,7%
60,2%
57,8%
5
4,4
5,5
5,9
11,7
14
12
11
AGE (mean)
EDSS (mean)
DURATION(mean)
CRITERIION 1
CRITERION 2
CRITERION 3
Symbols
CRITERION
CRITERION 5
4
HEMODYNAMIC MAP MORPHOLOGICAL
Symbols
RESULTS
HEMODYNAMIC STENOSIS
MORPHOLOGICAL STENOSIS
IJV Hemodynamic stenosis
IJV Morphological Stenosis
CCA
• We found a statistically significant prevalence of CCSVI within young and adults (young: positive 75,3%, negative 24,7% ;
adults: pos 85,7%, negative 14,3% ) with data similar of the international scientific studies .
• Our study showed a uniformly distribution, in both groups, of all the CCSVI Criteria, in particular the Criteria 3 (IJV stenosis).
• Therefore the results of our study showed a statistically significant difference in the presence of the Criteria4 (Flow not Doppler
detectable in the IJVs and Vertebral Veins; young : 50% and adults: 65% with p<0,001) .
• The same statistically significant difference for the EDSS was present between young and adult patients (young mean 3 and
adults mean 5, p<0,001).
CONCLUSION
• Hemodynamic Map Morphological enables us to see the presence of CCSVI, it simplifies the job of reporting to the operator and it facilitates statistical analysis of the CCSVI criteria; we
believe that future studies are needed to explain a definite the correct use by scientific community.
• We believe that the “Criteria 4” is not only a block intra-venous but it could mean a external compression of a normal vein (IJVs). This vein with compression, that is not visible in the
orthostatic and/or supine posture because empty in realty, expands itself with changes the position of the neck or Valsalva maneuver. Therefore this external compression, that create block
intra-venous (IJVs), could be related to postural behavior and the increased of EDSS.