CCSVI and Multiple Sclerosis
Zamboni and other researchers have been studying whether treating CCSVI by opening up blocked veins can improve symptoms of MS. The treatment for CCSVI is called endovascular surgery, or sometimes "liberation therapy" or the "liberation procedure." It involves placing a tiny balloon or tube called a stent inside a blocked vein to open it and restore blood flow out of the brain and spinal cord.
When Zamboni studied this surgery in a group of MS patients, he found that it did reduce relapses and the number of new brain lesions. Other studies have not found the same improvement. Some people with MS who've had the endovascular procedure claimed they felt better afterward, but researchers say this may be due to people's high hopes about the surgery outcome.
Should You Be Treated for CCSVI?
CCSVI is treated with surgery, and any type of surgery can have risks. "There have been some patients who have been seriously injured or have died as a result of this surgery," Fox says. Risks involved with endovascular surgery include:
- Movement of the stent
- Damage to the blood vessel, which could lead to clots
- Bleeding from the blood thinners prescribed after surgery
- Re-closing of the vein after surgery--called restenosis
In May 2012, the FDA released a statement warning people with MS about the risks of surgery used to treat CCSVI. The statement cautions that these procedures have not been FDA-approved or proven safe and effective for treating MS.
"We need to stop this use of treatment when we don't know if it's useful or not," says Robert Zivadinov, MD, PhD, professor of neurology at the University at Buffalo. He says endovascular surgery needs to be proven in carefully controlled studies before it can safely be used on people with MS.
The Future of CCSVI Research
So is CCSVI real? And can its treatment change the course for people with MS? The answer depends on which expert you ask.
"I think in many people's minds the issue has been sorted out," Fox says. He says his team is in the process of completing its studies, "but there does not seem like there is evidence in support of CCSVI. I think for many people this hypothesis of MS is winding down."
But Zivadinov says researchers who claim CCSVI doesn't exist are not interpreting the diagnostic criteria correctly. "Our studies are demonstrating that clearly there is this condition, and it's present in about 30% to 50% of the subjects," he says.
"Although this is a very controversial field, I am very certain that research should proceed," Zivadinov adds. He says it's important to keep studying CCSVI, to understand what it means for people with MS and other nervous system conditions.
Several studies are under way to learn more about CCSVI -- whether it is a real condition, and, if so, what its relationship to MS is. In Canada, a group of researchers is launching a study to investigate the safety and effectiveness of surgery on about 100 people with MS. What they and other research teams discover may answer many of the remaining questions about CCSVI and its treatment.