Percutaneous Venous Angioplasty in Patients With Multiple Sclerosis And Chronic Cerebrospinal Venous Insufficiency: A Randomized Wait List Control Study

Objectives: Venous percutaneous transluminal angioplasty (vPTA) in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) have shown contradictory results. Aim of the study is to evaluate the efficacy of the procedure in a randomized wait list control study. Materials: 66 adults with neurologist-confirmed diagnosis of MS and sonographic diagnosis of CCSVI were allocated in to vPTA-yes group (n=31) or vPTA-not group (n=35, control group). Venous PTA was performed immediately 15 days after randomization in PTA-yes group and 6 months later in the control group. Methods: Evoked potentials (EPs), clinical-functional measures (CFM) and upper limb kinematic measures (ULKM) were measured at baseline (T0) and six months after in both groups, just before the venous angioplasty in vPTA-not group (T1). Results: Comparing vPTA-yes and vPTA-not group, the CFM derived composite functional outcome showed 11(37%) versus 7(20%) improved, 1(3%) versus 3(8%) stable, 0 versus 7(20%) worsened and 19(61%) versus 18(51%) mixed patients (χ2=8.71, df=3, p=0.03). Unadjusted and adjusted (for baseline confounding variables) OR at 95% confident interval (95%CI) were respectively 1.93(1.3-2.8) P-value 0.0007 and 1.85(1.2-1.7) P-value 0.002. EPs and ULKM derived composite functional outcome showed no significant difference between the two groups. Conclusions: Venous angioplasty can positively impact a few CFM especially for the quality of life, but achieving disability improvement is unlikely