Napolitano Mariasanta, Bruno Aldo, Mastrangelo Diego, De Vizia Marcella, Bernardo Benedetto, Rosa Buonagura, De Lucia Domenico
aHematology Unit, Thrombosis and Hemostasis Reference Regional Center, University of Palermo, Palermo bDivision of Endovascular and Vascular Surgery, Clinic GEPOS Telese Terme, Benevento, Italy cFaculty of Medicine, University of Campobasso, Campobasso dDivision of Neurology, Second University of Naples (SUN), Napoli, Italy.
Blood Coagul Fibrinolysis. 2014 Oct;25(7):716-20. doi: 10.1097/MBC.0000000000000132.
We performed a monocentric observational prospective study to evaluate coagulation activation and endothelial dysfunction parameters in patients with multiple sclerosis undergoing endovascular treatment for cerebro-spinal-venous insufficiency. Between February 2011 and July 2012, 144 endovascular procedures in 110 patients with multiple sclerosis and chronical cerebro-spinal venous insufficiency were performed and they were prospectively analyzed. Each patient was included in the study according to previously published criteria, assessed by the investigators before enrollment. Endothelial dysfunction and coagulation activation parameters were determined before the procedure and during follow-up at 1, 3, 6, 9, 12, 15 and 18 months after treatment, respectively. After the endovascular procedure, patients were treated with standard therapies, with the addition of mesoglycan. Fifty-five percent of patients experienced a favorable outcome of multiple sclerosis within 1 month after treatment, 25% regressed in the following 3 months, 24.9% did not experience any benefit. In only 0.1% patients, acute recurrence was observed and it was treated with high-dose immunosuppressive therapy. No major complications were observed. Coagulation activation and endothelial dysfunction parameters were shown to be reduced at 1 month and stable up to 12-month follow-up, and they were furthermore associated with a good clinical outcome. Endovascular procedures performed by a qualified staff are well tolerated; they can be associated with other currently adopted treatments. Correlations between inflammation, coagulation activation and neurodegenerative disorders are here supported by the observed variations in plasma levels of markers of coagulation activation and endothelial dysfunction.
我们进行了一项单中心前瞻性观察性研究，以评估因脑脊髓静脉功能不全接受血管内治疗的多发性硬化症患者的凝血激活和内皮功能障碍参数。在2011年2月至2012年7月期间，对110例患有多发性硬化症和慢性脑脊髓静脉功能不全的患者进行了144例血管内手术，并对其进行了前瞻性分析。根据先前发表的标准，每位患者被纳入研究，并在入组前由研究人员进行评估。分别在手术前以及治疗后1、3、6、9、12、15和18个月的随访期间测定内皮功能障碍和凝血激活参数。血管内手术后，患者接受标准治疗，并加用甘糖酯。55%的患者在治疗后1个月内多发性硬化症病情得到改善，25%在接下来的3个月内病情好转，24.9%未从中获益。仅0.1%的患者出现急性复发，并接受了大剂量免疫抑制治疗。未观察到重大并发症。凝血激活和内皮功能障碍参数在1个月时降低，并在长达12个月的随访期内保持稳定，而且它们与良好的临床结果相关。由合格人员进行的血管内手术耐受性良好；它们可与目前采用的其他治疗方法联合使用。炎症、凝血激活与神经退行性疾病之间的相关性在此得到了凝血激活和内皮功能障碍标志物血浆水平观察变化的支持。
