Kostecki Jacek, Zaniewski Maciej, Ziaja Krzysztof, Urbanek Tomasz, Kuczmik Waclaw, Krzystanek Ewa, Ziaja Damian, Korzeniowski Tomasz, Majewski Eugeniusz, Hartel Marcin, Swiat Maciej, Sioma-Markowska Urszula
Department of Surgery, Medical University of Silesia, District Specialist Hospital, Tychy, Poland.
Neuro Endocrinol Lett. 2011;32(4):557-62.
In this study, the mid-term results (6 month follow-up) of the endovascular treatment in patients with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and multiple sclerosis (MS) were prospectively evaluated.
Thirty-six patients with confirmed MS and CCSVI underwent endovascular treatment by the means of the uni- or bilateral jugular vein angioplasty with optional stent placement. All the patients completed 6 month follow-up. Their MS-related disability status and quality of life were evaluated 1, 3 and 6 months postoperatively by means of the following scales: Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), Epworth Sleepiness Scale (ESS), Heat Intolerance scale (HIS) and Fatigue Severity Scale (FSS). For patency and restenosis rate assessment, the control US duplex Doppler examination was used.
Six months after the procedure, restenosis in post-PTA jugular veins was found in 33% of cases. Among 17 patients who underwent stent implantation into the jugular vein, restenosis or partial in-stent thrombosis was identified in 55% of the cases. At the 6 month follow-up appointment, there was no significant improvement in the EDSS or the ESS. The endovascular treatment of the CCSVI improved the quality of life according to the MSIS-29 scale but only up to 3 months after the procedure (with no differences in the 6 month follow-up assessment). Six months after the jugular vein angioplasty (with or without stent placement), a statistically significant improvement was observed only in the FSS and the HIS.
The endovascular treatment in patients with MS and concomitant CCSVI did not have an influence on the patient's neurological condition; however, in the mid-term follow-up, an improvement in some quality-of-life parameters was observed.
本研究前瞻性评估慢性脑脊髓静脉功能不全（CCSVI）合并多发性硬化（MS）患者血管内治疗的中期结果（6个月随访）。
36例确诊为MS和CCSVI的患者接受了单侧或双侧颈静脉血管成形术并选择性置入支架的血管内治疗。所有患者均完成了6个月的随访。术后1、3和6个月通过以下量表评估其与MS相关的残疾状况和生活质量：扩展残疾状态量表（EDSS）、多发性硬化症影响量表（MSIS-29）、爱泼华嗜睡量表（ESS）、不耐热量表（HIS）和疲劳严重程度量表（FSS）。采用超声双功多普勒检查评估通畅率和再狭窄率。
术后6个月，33%的病例发现经皮腔内血管成形术（PTA）后颈静脉再狭窄。在17例接受颈静脉支架植入的患者中，55%的病例发现再狭窄或支架内部分血栓形成。在6个月的随访中，EDSS或ESS没有显著改善。根据MSIS-29量表，CCSVI的血管内治疗改善了生活质量，但仅在术后3个月内（6个月随访评估无差异）。颈静脉血管成形术（无论是否置入支架）6个月后，仅在FSS和HIS方面观察到有统计学意义的改善。
MS合并CCSVI患者的血管内治疗对患者的神经状况没有影响；然而，在中期随访中，观察到一些生活质量参数有所改善。
