(Please note: we are participating in a national multi-center registry the goal of which is to collect data which will ultimately be used to better understand CCSVI and its treatment. The information in this section is preliminary and is subject to change as more data is collected.)
The central nervous system (CNS) consists of the brain and the spinal cord. CCSVI (Chronic cerebrospinal venous insufficiency)is a condition wherein the veins responsible for carrying blood out of the CNS are compromised by areas of narrowing called "stenoses". This causes blood, which has entered the brain and spinal cord via arteries, to build up like water behind a dam. This backed-up blood causes a pressure increase in the smaller veins in the brain and spinal cord. One of the consequences of this increased pressure is that red blood cells begin to leak out of the veins and into the brain and spinal cord tissues. Ultimately, these red blood cells cause an inflammatory reaction which can damage the brain and spinal cord. This theory is not a new one but has recently seen a resurgence following the publication of Dr. Paolo Zamboni's study.
The set of symptoms for which CCSVI is responsible is a topic which is currently being researched and debated in the medical community. The currently available data suggest (but have not proven) that symptoms such as headache, fatigue and "brain fog" (memory problems, difficulty concentrating, a detached feeling) can improve following treatment of CCSVI. One could make the argument that, therefore, these are symptoms of CCSVI; however, more research on this is needed before a consensus can be reached.
There are several ways to diagnose CCSVI. At Valley Endovascular we prefer using a combination of MRI scans called the Haacke protocol. This consists of a standard MRI of the brain, an MRV, flow quantification and SWI. The standard MRI allows us to see plaques and other brain abnormalities and to assess for changes following treatment. The MRV is a study which takes high definition pictures of the veins primarily responsible for draining blood from the central nervous system. This allows us to assess for stenoses. Flow quantification allows us to assess for reflux (blood flowing back into the CNS instead of out) and slow flow in these veins. SWI allows us to see iron building up in the brain, which is thought to be an indirect sign of red blood cells leaking out of veins and settling adjacent to brain cells.
If the Haacke protocol MRI shows a stenosis or shows abnormal flow suggesting a stenosis, we then perform an x-ray dye study called a "venogram". To do this study we insert a catheter (a thin tube the size of a strand of spaghetti) into a vein in the groin through a small hole in the skin (after the skin has been numbed up with an anesthetic). With x-ray guidance, we then push the catheter through the veins of the body until it reaches the veins primarily responsible for draining blood from the CNS (the internal jugular veins and azygos vein). A dye visible on x-ray is then injected through the catheter and x-ray pictures of the veins are obtained.
If the venogram confirms that there are areas of narrowing in the internal jugular or azygos veins, these stenoses are immediately treated with a procedure called angioplasty or venoplasty. Angioplasty involves inserting a catheter which has a deflated balloon at its end through the existing catheter in the groin. This balloon catheter is guided using x-ray to the stenosis. The balloon is then inflated to open-up the stenosis. During this inflation patients typically feel only a temporary sensation of pressure. Following the procedure there is a two hour recovery period after which you are allowed to go home.
If you have had angioplasty you will be started on a blood thinner which you will need to take for 20 days. You will also need to take a baby aspirin a day for 3 months. Your treating physician will see you in our office a week after the procedure. To assess your response to the angioplasty you will fill-out an online questionnaire 1 month, 6 months and 12 months after the procedure. You will also have follow-up Haacke protocol MRI's 6 and 12 months following the procedure.
Copyright 2011 Valley Endovascular Associates, All Rights Reserved