Researchers reported that performing angioplasty is safe—and may be an effective way to treat the venous abnormalities found in those with multiple sclerosis (MS) and provide symptom relief. The findings, which refute a common misconception about the treatment, were presented March 25 at the Society of Interventional Radiology (SIR) scientific meeting in San Francisco.
"These early results show that performing angioplasty on azygos and jugular vein lesions may have a positive impact on the symptoms of those individuals with MS and also could be an effective palliative treatment geared toward improving their quality of life," Hector Ferral, MD, an interventional radiologist at NorthShore University HealthSystem in Evanston, Ill., said in a statement.
"Our experience showed that 95 percent of the individuals we evaluated had venous obstructions, supporting the concept that venous lesions are common in individuals with multiple sclerosis," said Ferral.
"Based on follow-up that included ultrasound one week post procedure and clinic visits every three months, our results showed that people who have this treatment are not exposed to fatal risks. It is our belief that portraying venous angioplasty of the azygos and jugular veins as a high-risk procedure is a widespread misconception that needs to be addressed and corrected," he noted.
This retrospective study examined the results of 105 procedures performed in 94 individuals with MS (age range, 26-67 years old; 35 men, 59 women). This study's subgroups included 50 percent relapsing remitting, 39 percent secondary progressive, 6.4 percent primary progressive and 4.2 percent unknown.
Jugular and azygos veins were evaluated with selective venography and intravascular ultrasound. Imaging confirmed stenosis in 94.9 percent of patients. A total of 179 veins showed venous stenosis. Angioplasty was performed if the imaging confirmed reflux, or a greater than 50 percent decrease in the vessel's diameter. If necessary, stents were then used to treat nonresponsive lesions or blockages. These patients were given blood-thinning medications for six weeks after the treatment.
Ferral's team reported symptomatic improvement in 55 percent of the individuals treated, and 38 percent reported no improvement. Seven percent of patients did not comply with their follow-up visits and were considered to be lost to follow-up. Complications included jugular thrombosis in three patients and bleeding at puncture site in three patients.
Close to 60 percent of those with relapsing remitting MS reported improvement in symptoms, the highest of all the subgroups in this study.
In 2011, members of the SIR panel noted that evaluating people with MS who have narrowed jugular and azygos veins—and examining the value of widening those veins with angioplasty—warranted careful, well-designed research. The multidisciplinary panel indicated that the "mandatory goal" should be through large-scale, pivotal multicenter trials to explore chronic cerebrospinal venous insufficiency.