ABSTRACT
The aim of this study was to assess the prevalence of chronic cerebrospinal venous insufficiency in an unselected cohort of multiple sclerosis (MS) patients. A total of 586 patients with clinically defined MS underwent catheter venography of the internal jugular veins, brachiocephalic veins and azygos vein. The following findings were regarded as pathologic: no outflow, slowed outflow, reversal of flow direction, prestenotic dilation accompanied by impaired outflow, outflow through collaterals, intraluminal structures obstructing the vein, hypoplasia, agenesia or significant narrowing of the vein. Venous abnormalities were found in 563 patients (96.1%). Lesions in one vein were found in 43.5%, in two veins in 49.5%, and in three veins in 3.1% of patients. Venous pathologies in the right internal jugular vein were found in 64.0% of patients, in the left internal jugular vein in 81.7%, in the left brachiocephalic vein in 1.0%, and in the azygos vein in 4.9%. Venous pathologies were found to be highly associated with MS, yet the clinical relevance of this phenomenon remains to be established.
Subject(s)
Cerebral Veins/abnormalities , Cerebral Veins/diagnostic imaging , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/epidemiology , Multiple Sclerosis/epidemiology , Adolescent , Adult , Aged , Azygos Vein/abnormalities , Azygos Vein/diagnostic imaging , Brachiocephalic Veins/abnormalities , Brachiocephalic Veins/diagnostic imaging , Female , Humans , Jugular Veins/abnormalities , Jugular Veins/diagnostic imaging , Male , Middle Aged , Phlebography/statistics & numerical data , Prevalence , Young AdultABSTRACT
OBJECTIVES: The aim of this report is to assess the safety of endovascular treatment for chronic cerebrospinal venous insufficiency (CCSVI). Although balloon angioplasty and stenting seem to be safe procedures, there are currently no data on the treatment of a large group of patients with this vascular pathology. METHODS: A total of 564 endovascular procedures (balloon angioplasty or, if this procedure failed, stenting) were performed during 344 interventions in 331 CCSVI patients with associated multiple sclerosis. RESULTS: Balloon angioplasty alone was performed in 192 cases (55.8%), whereas the stenting of at least one vein was required in the remaining 152 cases (44.2%). There were no major complications (severe bleeding, venous thrombosis, stent migration or injury to the nerves) related to the procedure, except for thrombotic occlusion of the stent in two cases (1.2% of stenting procedures) and surgical opening of femoral vein to remove angioplastic balloon in one case (0.3% of procedures). Minor complications included occasional technical problems (2.4% of procedures): difficulty removing the angioplastic balloon or problems with proper placement of stent, and other medical events (2.1% of procedures): local bleeding from the groin, minor gastrointestinal bleeding or cardiac arrhythmia. CONCLUSIONS: The procedures appeared to be safe and well tolerated by the patients, regardless of the actual impact of the endovascular treatments for venous pathology on the clinical course of multiple sclerosis, which warrants long-term follow-up.
Subject(s)
Endovascular Procedures/methods , Venous Insufficiency/therapy , Adolescent , Adult , Aged , Angioplasty, Balloon/adverse effects , Central Nervous System Diseases/complications , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/therapy , Chronic Disease , Endovascular Procedures/adverse effects , Female , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Multiple Sclerosis/diagnosis , Multiple Sclerosis/therapy , Phlebography , Postoperative Complications , Stents/adverse effects , Venous Insufficiency/complications , Venous Insufficiency/diagnosis , Young AdultABSTRACT
The aim of this study was to characterize the immunohistological components of chronic inflammation in endarterectomy lesions. Therefore, in 24 patients endarterectomy specimens were obtained from coronary arteries during CABG surgery (16 from RCA and 8 from LCA) and immunohistologically analyzed using avidin-biotin method (LSAB(R)/AP) with monoclonal antibodies. Macrophages and CD3 lymphocytes were counted under 200x magnification but MHC class II and ICAM-1 adhesion molecules were analyzed semi-quantitatively (scale from 0 to 3+). The mean macrophages density was 47.8+/-9.8 cells per mm2 and mean CD3 lymphocyte density was 1.3+/-0.6 cells per mm2. Lack or weak expression of HLA-DR (0-1+) on macrophages was found in 17 of 24 cases (70.8%). In the remaining seven cases (29.2%) there was a moderate and strong expression (2+ and 3+) of HLA-DR antigens. Similarly, no or weak ICAM-1 expression on macrophages was detected in 19 cases (79.2%). These cells were positively stained for ICAM-1 in only five cases (20.8%). Our data suggest that in advanced primary atherosclerotic lesions chronic inflammation is still present. On the other hand, the small number of activated inflammatory cells and the absence of positively stained endothelium suggests that inflammatory process tends to be burnt-out.