STUDY OF THE CHRONIC CEREBRO-SPINAL VENOUS INSUFFICIENCY IN A POPULATION OF YOUNG PEOPLE WITH MULTIPLE SCLEROSIS BY HEMODYNAMIC MAP MORPHOLOGICAL

S. MANDOLESI; F. L. CICIARELLO; F. FEDELE; L. AGATI, A. MARCECA; UNIVERSITY SAPIENZA , DEPARTMENT OF CARDIOVASCULAR DESEASE , ROME, ITALY

BACKGROUND: Multiple Sclerosis (MS) is the most common autoimmune neurological disorder in young adults. There are several different clinical types: Relapsing Remitting-MS (RR); Secondary Progressive –MS (SP); Primary Progressive –MS (PP). Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) is a new vascular pattern recently identified by Zamboni, who associated CCSVI with MS.

MATERIALS AND METHOD: we included in this study 668 patients affected by MS (all clinical types) . We divided them in 194 young patients: CCSVI positive 75,3 % (n=146) and CCSVI negative 24,7 % (n=48); 474 adult patients: CCSVI positive 85,7 % (n=406) and CCSVI negative 14,3 % (n=68). We studied only CCSVI positive population : 146 young patients CCSVI positive (GROUP 1), mean duration disease <5 years (women 58,9%, n=86; men 41,1%, n=60; mean age 25 years; mean Expanded Disability Disease Score, EDSS 3); adult patients (GROUP 2) was composed of 406 CCSVI and mean duration disease >5 years (women 60,8%, n=247; men 39,2%, n=159; mean age 47 years; mean EDSS 5). We investigated the population by means of high resolution B-mode ultrasounds (MyLab Vinco ECD System, equipped with 2.5 and 7.5-10 Mhz probes) and hemodynamic according to Zamboni’s criterion to diagnose the CCSVI: 1-Reflux in the Internal Jugular Veins (IJVs) and/or Vertebral Veins (VVs); 2-Reflux in the Internal cerebral veins (DCVs); 3 -High-resolution B-mode-evidence of proximal IJV stenosis (Morphological and Hemodynamic stenosis); 4-Flow not Doppler detectable in the IJVs and/or VVs (block intra-venous); 5-Reverted postural control of the main cerebral venous outflow pathway, investigating in both positions (0°and 90°). The ECD examinations were then reported on Hemodynamic Map Morphological (HMM), it’s a new digital computerized software, created in our school, where the operator inserts symbols that correspond to the five Zamboni criteria.

CONCLUSION

RESULTS

• Hemodynamic Map Morphological enables us to see the presence of CCSVI, it simplifies the job of reporting to the operator and it facilitates statistical analysis of the CCSVI criteria; we

believe that future studies are needed to explain a definite the correct use by scientific community.

• We believe that the “Criteria 4” is not only a block intra-venous but it could mean a external compression of a normal vein (IJVs). This vein with compression, that is not visible in the

orthostatic and/or supine posture because empty in realty, expands itself with changes the position of the neck or Valsalva maneuver. Therefore this external compression, that create block

intra-venous (IJVs), could be related to postural behavior and the increased of EDSS.

• We found a statistically significant prevalence of CCSVI within young and adults (young: positive 75,3%, negative 24,7% ;

adults: pos 85,7%, negative 14,3% ) with data similar of the international scientific studies .

• Our study showed a uniformly distribution, in both groups, of all the CCSVI Criteria, in particular the Criteria 3 (IJV stenosis).

• Therefore the results of our study showed a statistically significant difference in the presence of the Criteria4 (Flow not

Doppler detectable in the IJVs and Vertebral Veins; young : 50% and adults: 65% with p<0,001) .

• The same statistically significant difference for the EDSS was present between young and adult patients (young mean 3 and

adults mean 5, p<0,001).

72° SIC CONGRESS, 10-12 December 2011

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HEMODYNAMIC STENOSIS

IJV Hemodynamic stenosis

MORPHOLOGICAL STENOSIS

IJV Morphological Stenosis

CCA

Symbols

AIM: we analyzed the presence of CCSVI in a young population with less than 30 years old affected by MS, following Zamboni’s five ultrasound criteria and using an Hemodynamic Map Morphological (HMM), versus a large sample of adult patients with MS and more than 30 years old.

CRITERIION 1

BASELINE CCSVI posYOUNG(<30 years old)

GROUP 1 ( n= 146)

RR-MS 76,7%(n=112 )

SP-MS 15%(n= 22)

PP-MS 8,3%(n=12)

AGE (mean) 30,6 30,3 31,9 30,3

MALE 41,1% 41,1 % 45,5% 33,3%

FEMALE 58,9 % 58,9% 54,5% 66,7%

EDSS (mean) 3 3,1 4,2 4

DURATION(mean) 5,1 5,2 4,7 4,6

BASEL INE CCVSI posADULT(>30 years old)

GROUP 2 (n=406)

RR-MS 62,3 %(n=253)

SP-MS 26,6%(n= 108)

PP-MS 11,1%(n=45)

AGE (mean) 47 46 49,6 50

MALE 39,2% 38,3 % 39,8 % 42,2 %

FEMALE 60,8 % 61,7% 60,2% 57,8%

EDSS (mean) 5 4,4 5,5 5,9

DURATION(mean) 11,7 14 12 11

Symbols

HEMODYNAMIC MAP MORPHOLOGICAL

CRITERION 2 CRITERION 3

CRITERION 4 CRITERION 5