Interventional radiologists advance multiple sclerosis research: venous angioplasty treatment safe

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Understanding that venous angioplasty‰ÛÓa medical treatment used by interventional radiologists to widen the veins in the neck and chest to improve blood flow‰ÛÓis safe may encourage additional studies for its use as a treatment option for individuals with multiple sclerosis, said researchers at the Society of Interventional Radiology‰Ûªs 36th Annual Scientific Meeting in Chicago, USA.

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‰ÛÏOur study will provide researchers the confidence to study angioplasty as a multiple sclerosis treatment option for the future,‰Û said Kenneth Mandato, interventional radiologist, Albany Medical Center, Albany, USA. In a retrospective study, 231 multiple sclerosis patients (age range, 25 to 70 years old; 63.7% women, åÊ36.3%men) underwent this endovascular treatment of the internal jugular and azygos veins with or without placement of a stent. ‰ÛÏOur results show that such treatment is safe when performed in the hospital or on an outpatient basis‰ÛÓwith 97% treated without incident,‰Û Mandato noted.

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He added, ‰ÛÏOur study, while not specifically evaluating the outcomes of this endovascular treatment, has shown that it can be safely performed, with only a minimal risk of significant complication. It is our hope that future prospective studies are performed to further assess the safety of this procedure.‰Û Complications included abnormal heart rhythm in three patients and the immediate re-narrowing of treated veins in four patients. All but two of the patients were discharged within three hours of receiving this minimally invasive treatment.

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About 500,000 people in the United States have multiple sclerosis. ‰ÛÏThere are few treatment options that truly improve the quality of life of those with the disease, and some of the current drug treatment options for multiple sclerosis carry significant risk,‰Û said Mandato. In 2009, Paolo Zamboni, a doctor from Italy, published a study that suggested that chronic cerebrospinal venous insufficiency (CCSVI) might contribute to multiple sclerosis and its symptoms. The idea is that if these veins were widened, blood flow may be improved, which may help lessen the severity of multiple sclerosis-related symptoms.

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The Society of Interventional Radiology issued a position statement in Autumn 2010 supporting high-quality clinical research to determine the safety and effectiveness of interventional multiple sclerosis treatments, recognising that the role of CCSVI in multiple sclerosis and its endovascular treatment by an interventional radiologist via angioplasty could be transformative for patients. ‰ÛÏThis is an entirely new approach to the treatment of patients with neurologic conditions, such as multiple sclerosis. The idea that there may be a venous component that causes some symptoms in patients with multiple sclerorosis is a radical departure from current medical thinking,‰Û said Gary P Siskin, interventional radiologist and chair of the Radiology Department, Albany Medical Center and the co-chair of the SIR research consensus panel on multiple sclerosis held in October 2010.

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‰ÛÏIt is important to understand that this is a new approach to multiple sclerosis. As a result, there is a healthy level of skepticism in both the neurology and interventional radiology communities about the condition, the treatment and the outcomes,‰Û said Siskin. ‰ÛÏInterventional radiologists have been performing venous angioplasty for decades and have established themselves as pioneers in this area of vascular intervention.‰Û

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While the use of angioplasty and stents cannot be endorsed yet as a routine clinical treatment for multiple sclerosis, SIR agrees that the preliminary research is very promising and supports studies aimed at understanding the role of CCSVI in multiple sclerosis, at identifying methods to screen for the condition and at designing protocols for exploratory therapeutic trials. ‰ÛÏIf interventional therapy proves to be effective, multiple sclerosis patients should be treated by doctors who have specialised expertise and training in delivering image-guided venous treatments,‰Û said Siskin. Interventional radiologists pioneered angioplasty and stent placements and use those treatments on a daily basis in thousands of patients with diverse venous conditions.

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Mandato noted that research still needs to be done concerning patient selection, technique and the outcomes after this procedure, including improvement in symptoms and quality of life and the durability of the response.

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