["Chronic cerebrospinal venous insufficiency" in multiple sclerosis - is multiple sclerosis a disease of the cerebrospinal venous outflow system?].

TY - JOUR

T1 - ["Chronic cerebrospinal venous insufficiency" in multiple sclerosis - is multiple sclerosis a disease of the cerebrospinal venous outflow system?].

AU - Wattjes, M P

AU - Doepp, F

AU - Bendszus, M

AU - Fiehler, Jens

PY - 2011

Y1 - 2011

N2 - Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients.

AB - Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients.

KW - Humans

KW - Central Nervous System/blood supply

KW - Cerebral Veins/pathology/physiopathology/ultrasonography

KW - Multiple Sclerosis/complications/pathology/physiopathology/surgery

KW - Phlebography

KW - Venous Insufficiency/etiology/physiopathology/surgery

KW - Humans

KW - Central Nervous System/blood supply

KW - Cerebral Veins/pathology/physiopathology/ultrasonography

KW - Multiple Sclerosis/complications/pathology/physiopathology/surgery

KW - Phlebography

KW - Venous Insufficiency/etiology/physiopathology/surgery

M3 - SCORING: Zeitschriftenaufsatz

VL - 183

SP - 523

EP - 530

JO - ROFO-FORTSCHR RONTG

JF - ROFO-FORTSCHR RONTG

SN - 1438-9029

IS - 6

M1 - 6

ER -