Chronisch venöse Insuffizienz als Ursache der Multiplen Sklerose?

Zusammenfassung

Kürzlich wurde die sog. chronische zerebrospinale venöse Insuffizienz („CCSVI“) als neue Hypothese zur Pathogenese der Multiplen Sklerose (MS) von Zamboni et al. postuliert: Hiernach führt eine Behinderung des zerebrozervikalen venösen Abstroms zu einer Stase in zerebralen Venen und zu einer transendothelialen Extravasation von Erythrozyten mit nachfolgender Entzündungsreaktion im Gewebe. Basierend auf dieser Hypothese und eigenen sonografischen sowie angiografischen Daten wurden therapeutische Interventionen mittels Angioplastie zur Behandlung der MS von Zamboni et al. propagiert. Die „CCSVI“-Hypothese, von ihren Erfindern als „die große Idee“ bezeichnet, hat beträchtliches Interesse nicht nur unter Wissenschaftlern und Ärzten, aber auch bei Patienten, Angehörigen und in den Massenmedien erzeugt. Bislang fehlt jedoch eine Reproduktion der Ergebnisse durch unabhängige Arbeitsgruppen, und die Zahl der negativen Publikationen, die mit verschiedenen Verfahren die „CCSVI“-Hypothese in Frage stellen, steigt kontinuierlich. Diese Übersichtsarbeit fasst die „CCSVI“-Theorie und die Zamboni-Daten zusammen und stellt diesen die neueren, überwiegend kritischen Arbeiten gegenüber. Nach dem gegenwärtigen Stand des Wissens gibt es keine wissenschaftliche Plausibilität für die „CCSVI“-Hypothese und keine weiteren Daten, die diese stützen würden. Daher gibt es keine Indikation und Rechtfertigung für angioplastische Interventionen bei Patienten mit MS.

Abstract

Recently, chronic cerebrospinal venous insufficiency („CCSVI“) was suggested as a new pathogenetic hypothesis in multiple sclerosis (MS) by Zamboni and colleagues: impairment of the cerebrocervical venous outflow by venous stenoses or other vessel obstructions should lead to stasis in cerebral veins with transendothelial extravasation of erythrocytes and subsequent inflammatory reactions in brain tissue. Based on this hypothesis and their own sonographic and angiographic data, therapeutic interventions by means of angioplasty were proposed as treatment for MS by Zamboni et al.. The “CCSVI” hypothesis, termed “the big idea” by Zamboni and colleagues, has caused substantial interest in the scientific community as well as amongst patients, caregivers, and the mass media. However, an independent confirmation of the data published by Zamboni et al. is lacking, while the number of negative studies with various techniques that question the „CCSVI“ hypothesis is steadily increasing. The aim of this review is to delineate the „CCSVI“ hypothesis and to summarise the data published by Zamboni et al. and subsequent investigators which mostly refute this hypothesis. According to the current evidence, there is no scientific plausibility of the “CCSVI” hypothesis and no further data that support this pathogenetic concept. Thus, there is no justification for any angioplastic therapies in MS patients.

Schlüsselwörter

Zerebrale venöse Drainage - Multiple Sclerose - Ultraschall

Key words

cerebral venous drainage - multiple sclerosis - ultrasound

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