What is CCSVI
Chronic cerebrospinal venous insufficiency (CCSVI) is the name proposed in 2006 by Paolo Zamboni, MD, professor at the University of Ferrara, Italy to describe poor venous drainage from the brain and spinal cord. The basic idea is that if the veins in the neck and chest that drain the central nervous system are not functioning properly, the central nervous system will not function properly either. In particular, myelin-making cells around the smallest veins, called venules, will be damaged; inflammation will set in, nerve cells will eventually die causing blindness, weakness, loss of normal sensation, imbalance, memory and cognitive deficiencies.
Traditionally, these multiple areas of scar tissue (“multiple sclerosis” is the most well-known form) have been treated with potent anti-inflammatory medications with limited success. The re-awakening of interest in venous causes of scar tissue, especially in white matter, holds the promise of an entirely different treatment strategy. Rather than wait for inflammation to destroy neuron fibers, the idea is to treat the drainage problems prophylactically. Presently, the focus is on the venous blockages that are easy to treat, the internal jugular veins, and the azygos vein (which drains the spinal cord) that can be reached by catheters placed in the veins of the legs and guided up to the chest and neck. Although criticized by the neurology community as premature, the identification of venous obstructions and the dilation of them with balloons and/or stents are progressing rapidly. Unfortunately, at least 10% and is high as 40% of treated patients have no improvement or have restenosis, meaning the treated vein collapses again or the stent becomes clogged with scar tissue. What is desperately needed is the ability to predict who will benefit and who will not, and to recognize restenosis when it occurs. Ultimately, what is needed is a way to directly measure venous drainage in the central nervous system; this should make it possible to predict who will benefit from treatment, but also to predict when myelin cells will die and inflammation will occur, and to redirect treatments toward prevention of this cascade of events.
Advances will come quickly. Device makers will create better balloons and stents. Interventional radiologists will explore smaller veins closer to the brain and the spinal cord. Magnetic resonance techniques, such as functional MRI, arterial spin labeling, perfusion, and susceptibility-weighted imaging, will make measurement of CNS drainage increasingly accurate. It is also likely that the pharmaceutical industry, presently supporting immunosuppressant drugs, will eventually explore and develop ways to promote endothelial health and reduce drainage toxicity.
Click HERE to see video clips about Dr. Hubbard and his theory of CCSVI.
This video explains the dynamics of CCSVI and Multiple Sclerosis, by Paolo Zamboni, MD (Italy).