CCSVI: Hype or Hope?

Paolo Zamboni from Italy discovered that the draining veins from the brain (internal jugular veins) and from the spinal cord (azygous vein) are often blocked or narrowed.  The theory of CCSVI (chronic cerebrospinal venous insufficiency)  is that blood can then back flow into the veins of the brain and spinal cord, leading to iron deposition and blood vessel wall inflammation.

Zamboni performed a trial of opening of the vein blockages with angioplasty in 65 MS patients.  Patients had less relapses and MRI activity after treatment, but there was no comparison group that got a fake “sham” procedure.  Previous trials of patients on no treatment (placebo group) show less relapses and MRI activity over time naturally so follow-up larger studies are needed to see if this treatment is really effective.   There also has been reports of a fatal brain bleed after stenting and a stent moving into the heart so trials will be necessary to see if stenting works if indeed people with MS have more frequent vein blockages.

Overall, an intriguing observation that needs to be verified at other centers.  Is the vein blockages causing MS or simply the result of MS inflammation on the veins?    Further research is needed!