An overview of randomized controlled trials on endovascular treatment for chronic cerebrospinal venous insufficiency in multiple sclerosis patients

Abstract

About ten years ago it was hoped that venous angioplasty for abnormal veins, primarily the internal jugular veins, will be a much awaited treatment for multiple sclerosis. Yet, a majority of randomized clinical trials on endovascular treatment for chronic cerebrospinal venous insufficiency did not reveal clinical efficacy of these procedures in multiple sclerosis patients. Still, a detailed analysis of these trials suggests that they were poorly designed, underpowered and endovascular techniques used were often far from being optimal. Nonetheless, even considering weak points of these trials, it can be concluded that venous angioplasty should not be used as a routine treatment modality in multiple sclerosis patients. Still, a possibility that some patients may benefit from endovascular treatment cannot be ruled out. This may concern patients at early stage of the disease and presenting with lesions that can easily be managed with balloon angioplasty. Therefore, we need more studies evaluating clinical efficacy of venous angioplasty in selected subgroups of multiple sclerosis patients. Importantly, it has already been demonstrated that venous angioplasty in multiple sclerosis patients is a safe procedure. Thus, also from an ethical point of view, such trials seem justifiable.

Zusammenfassung

Vor 10 Jahren wurden Studien vorgestellt, die die venöse Angioplastie bei Gefäßläsionen der V. jugularis interna als lang erwartete Behandlungsmöglichkeit der multiplen Sklerose vorstellten. Allerdings ergaben die daraufhin durchgeführten randomisierten klinischen Studien zur endovaskulären Behandlung bei chronischer zerebrospinaler Veneninsuffizienz sehr unterschiedliche Ergebnisse und im Wesentlichen keine Bestätigung der klinischen Wirksamkeit dieser Verfahren bei Patienten mit multipler Sklerose. Eine detaillierte Analyse dieser Studien lässt jedoch vermuten, dass die Studien schlecht konzipiert waren und möglicherweise nicht ausreichend Erfahrung mit den eingesetzten endovaskulären Techniken vorlag. Aber auch unter Berücksichtigung der Schwachstellen dieser Studien kann der Schluss gezogen werden, dass die venöse Angioplastie nicht als Routinebehandlung bei Multiple-Sklerose-Patienten eingesetzt werden sollte.

Allerdings scheint es so, dass die endovaskuläre Behandlung, wie im ursprünglichen Artikel dargestellt, bei einigen Patienten hilfreich sein kann. Das sind besonders Patienten in einem frühen Stadium der Krankheit, die Läsionen aufweisen, die mit einer Ballonangioplastie leicht zu behandeln sind. Daher sind weitere Studien notwendig, die die klinische Wirksamkeit der venösen Angioplastie in ausgewählten Untergruppen von Patienten mit multipler Sklerose untersuchen. Diese Studien erscheinen aus ethischer Sicht gerechtfertigt, da bereits erwiesen wurde, dass die venöse Angioplastie bei Patienten mit multipler Sklerose ein sicheres Verfahren ist.

Key words

chronic cerebrospinal venous insufficiency - internal jugular vein - multiple sclerosis - randomized clinical trial

Schlüsselwörter

chronische zerebrospinale Veneninsuffizienz - V. jugularis interna - multiple Sklerose - venöse Angioplastie

Publication History

Article published online:
09 April 2020

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