Author + information
- Marjeta Zorc1,
- Miro Denislic2,
- Zoran Milosevic3,
- Ales Pleskovic3,
- Rok Zorec1,
- Dean Ravnik1,
- Ruda Zorc Pleskovic1,
- Olga Vaspir Porenta1 and
- Oscar Mendiz4
The venous extracranial abnormalities in multiple sclerosis (MS) provide a new perspective in the treatment. The primary endpoint of our study was to evaluate the occurrence of venous obstructions in the extracranial venous pathway and the secondary endpoint to assess the effect of angioplasty on the clinical disability.
In MS patients with 2 or more of the required 5 sonographic criteria, under local anaesthesia selective catheter venography (CV) of the azygous (AZY) and the internal jugular veins (IJVs) was performed.
In our study 158 consecutive MS patients - 39 relapsing-remitting and 119 with progressive course of disease were included. In 6/158 patients (3.8%) CV did not reveal any vascular abnormality. The left IJV was more often affected (86%). Restenosis occurred in 21%. No major side effect was observed. In our study no stents were used. The brain biopsy tissue of the patients with the tumefactive form of MS demonstrated inflammatory perivenular changes with intact arteriolar wall. Also an intima thickening of IJV was found. The important improvement of clinical disability in the relapsing-remitting group was achieved (p<0.001). MS patients with the progressive course of disease reported an amelioration of the fatigue headache, spasms, bladder dysfunction and quality of life.
Our results support the contribution of venous obstructions in the extracranial venous pathway to the clinical picture of MS. The removal of venous abnormalities may importantly influence the degree of clinical disability. Recently, a close association between venous extracranial abnormalities and the presence of heart disease was reported.
- 2013 American College of Cardiology Foundation