1. Relationship between chronic cerebro-spinal venous insufficiency CCSVI and MS
L.Grozdinski and I.Petrov,
M.Iloska,M.Pavlova
Clinic of Angiology and Phlebology
Tokuda Hospital
Sofia, Bulgaria

2. Multiple sclerosis (MS)
This is an inflammatory, neurodegenerative, disease of the central neurological system (brain, spine);
It was first discovered by Charcot, 1868

3. Frequency and occurance
Two million people suffer from MS in the world
Highest frequency have North America and North Europe up to 80/

4. Specifics and prognosis
MS affects young people between 25 – 35 years;
Patients with MS live 5-10 years less than the rest of the people;
After 25 years over 50% of the patients become dissabled.

5. Axon – myelin affection
Autoimmune theory for development of MS Infection causing BBB breakdown, myelin affection - autoimmune reaction and MS
Genetic factors
Infections
BBB Breakdown
Virus
Attack
Causing
Axon – myelin affection
T-kyller
lymphocytes
Autoimmune reaction
Demyelination
Neuron MS
Lymphocytes

6. Unsolved questions
The ethiological and pathogenetic mechanism stil stay uncleared;
There′s no explanation why the BBB is breaking down;
There′s no explanation why the inflamatory reaction is around the cerebral vein;

7. 2009 P.Zamboni discovers CCSVI in patients with MS
CCSVI is congenital venous malformation – stenoses of internal jugular and azygous veins and insufficient cerebrospinal venous drainage.

8. Zambony`s theory of CCSVI- MS
Disturbed venous drainage
Venous hypertention
Disturbed of BBB
Migration of blood cells
Er – precipitation of iron
Irons causes neurodegeneration
CCSVI causes:

9. US – Color Doppler Study of Jugular vein
Total tesded – 550 patients
Control group – 50 p without MS;
Group A – 500 p with MS
Results:
Control group – 46 p without date for CCSVI and 4 p (8%) suspected for CCSVI
Group A (MS) – 461 p – 92,2% comfermed for CCSVI and 39 p – 7,8% without proven date for CCSVI

10. Bozev (MS)– Stenosis of Jugular vein – US screening

11. Zarev(MS) – Stenosis of IJV – US screening

12. K.G.( MS ). Valve stenosis of RIJV US - screening
I.P

13. A.R.(MS) Valve stenosis and insuff. of IJV US screening

14. Study with venography Exzamined - 461 p with CCSVI – MS found with US
Patients were from:
Bulgaria, Canada, UK, Irland,USA, Holand, Italy, France, Slovenia, Hungary, Greece, Suisse, Norwey,Litva, Macedonia, Croatia,Malta,Rumenia,Kipar,Harvatia

15. Forms of MS and clinical stage
Relapsing Remitting – 278 p – 55.6%
Primary progressive – 177 p – 35,4%
Secondary progressive – 38 p – 7,6%
Clinicaly isolated syndrom – 7 p – 1,4 %
EDSS – average – 5.2 stage
Continuance of MS – 9 years

16. Color Doppler screening of IJV
Total 550 p.
Control gr.О–50p. mean,SD, n , %
Gr.A– MS
500 p.
Gr.А1-461 p.
CCSVI
Gr.А2- 39 p.
Мах.D IJV в мм.
Min.D IJV в мм. * * *
min.d/max.d%
54%
20%*
19%*
36%
Stenosis in ІJV 5%
92%*
100%*
5 %
Reflux in IJV 7%
67 %*
70 %*
12 %
Reduction of
flow in IJV
6 %
50 %*
73%*
12%
-ΔCSA в IJV 2%
63%*
66%*
0 %
8 %
92 %*
CCSVI % %* %* %

17. Venography
In 461 patients with CCSVI –MS found by US , venography confirmed CCSVI in 100%;
Jugular vein stenoses – 461 p. – 100%
Jugular vein + Azygos stenoses – 339 p – 73,5%
Independetly jugular vein stenoses – 122 p, 26,4%
Stenoses were over 60% to 99%.

18. Venography - IJV -МS

19. Comparison - Color Doppler and venography CCSVI - MS
CCSVI 461 p.
1383 vein
ColorDoppler total 922 IJV
Venography
1383 n.,%
Vein stenosis – n vein
793
86 %
1112
80.4%
Vein stenosis -
patient
461
100%
Stenosis IJV – vein
86%
773
83.8%
Stenosis IJV – p.
Stenosis v.azygos -
339
73.5%

20. CCSVI -US Doppler diagnostic/Venography comparison
CCSVI diagnostic
US sensitivity – 98%;
Concurrence – 91,6%

21. Stenosis IJV before and after endovascular treatment

22. Stenosis vena azygos – before and after endovascular treatment

23. Clinical improvement after endovascular treatment
Early improvement up to one week – 81%;
Improvment up to 6 months – 60%

24. Venous theory of MS VT CCSVI - CVI Valve stenosis/ Stenosis
insufficiency
Stenosis
v. Jugularis/ Azygos
Reflux
VBP
venous drainage
Er (Fe)
fibrin ED
Destruction of BBB
Insufficiency
T-Lymp
infiltration
perivascular edema disturbed microcirculation
CO2 O2
progressive neurodegenerative disease
autoimmune process
Neurodegenerative disease - MS

25. Conclusion
In patients suffering from MS a high frequency of CCSVI is established (using US and Venography)
This proves relationship between MS and CCSVI.
MS simptoms improve after the endovascular treatment