Studies Show Promise for Angioplasty in Multiple Sclerosis

Laird Harrison

March 26, 2012

March 26, 2012 (San Francisco, California) — Two retrospective studies on angioplasty for multiple sclerosis have shown that the intervention improves some symptoms and raised questions about the cause of the disease, researchers reported here at the Society of Interventional Radiology 37th Annual Scientific Meeting.

"This is the first wave of research that has been presented that is beyond just the observational," Michael Dake, MD, professor of cardiothoracic surgery at Stanford University in Palo Alto, California, told Medscape Medical News. "It's a nice experience with a large group of patients."

Most practitioners view multiple sclerosis as an autoimmune disease and treat it with drugs that suppress the immune response. "The generally held view is that this is an autoimmune process that's not completely characterized," explained Dr. Dake, who was not involved with either of the studies.

Desperate for relief from a disease with no cure, many patients with multiple sclerosis seek out angioplasty, but there has been little evidence so far that the procedure is truly helpful.

The angioplastic approach arose from investigations into the connection between chronic cerebrospinal venous insufficiency and multiple sclerosis.

In one study, investigators from Rush University in Chicago, Illinois, reviewed 105 procedures in 94 patients diagnosed with multiple sclerosis using McDonald criteria from June 2010 to September 2011.

Of the 94 patients, 47 were categorized as relapsing remitting, 32 as secondary progressive, 6 as primary progressive, and 6 as unknown.

The investigators evaluated the jugular and azygos veins of the patients using selective venography and intravascular ultrasound. They performed angioplasty if venograms or ultrasound confirmed a decrease of more than 50% in luminal diameter or reflux.

If patients had nonresponsive lesions or occlusions, the surgeons placed stents in the affected veins.

They administered anticoagulants for 10 days and clopidogrel bisulfate for 6 weeks. They followed up with jugular ultrasound 1 week after the procedure and Multiple Sclerosis Impact Scale scores every 3 months.

In 5 of the patients (5.2%), venography and ultrasound were normal; in 89 (94.9%), there was evidence of stenosis.

The surgeons performed angioplasty in all the abnormal veins and put stents in 5 of 179 (2.8%).

Of the 89 patients with stenosis, 48 (53.9%) reported improvement in their symptoms, 15 (16.85%) reported questionable improvement, and 26 (29.20%) reported no improvement.

The patients with relapsing remitting disease reported the most improvement (59.6%). Complications included 3 instances of jugular vein thrombosis and 3 instances of bleeding at the puncture site. One patient died 4 months after the procedure of an unknown cause.

In the other study, researchers from the Albany Medical Center in New York examined the records of 213 patients. Of these, 189 (98.4%) underwent angioplasty and 3 (1.6%) underwent angioplasty with stent placement.

The researchers categorized 96 of the patients as relapsing remitting, 66 as secondary progressive, and 30 as primary progressive.

In the 192 patients, mean physical health scores on the Multiple Sclerosis Quality of Life questionnaire improved from 43.2 to 52.4 (P < .05). Mental health scores improved from 57.1 to 65.2 (P < .05). The index measures physical abilities, health perception, energy/fatigue, sexual function, emotional wellbeing, cognition, and pain.

Once again, the greatest improvement was in those with relapsing remitting disease — 77% reported a physical improvement and 74% reported a mental improvement. Of those with secondary progressive disease, 59% improved on the physical index and 50% improved on the mental index. Of those with primary progressive disease, 77% had a physical and 70% had a mental improvement. These changes were all statistically significant (P < .05).

"Results of the study were quite exciting and promising," said principal investigator Kenneth Mandato, MD, an interventional radiologist at the Albany Medical Center, in a statement.

Dr. Mandato called for a double-blind prospective study to assess the benefits of angioplasty in patients with multiple sclerosis.

Hector Ferrar, MD, professor of radiology at Northshore University, in Chicago, and principle investigator of the Rush study, told Medscape Medical News that the next step in research is to learn more about the obstructions in these patients' veins. "We don't know what kind of lesion it is," he said. "We think there are valves in the jugular vein that are either too thick or are not closing properly."

In the meantime, the treatment should be available to patients who ask for it. "We have a good enough justification to do this procedure," said Dr. Ferrar.

Dr. Ferrar and Dr. Dake have disclosed no relevant financial relationships.

Society of Interventional Radiology (SIR) 37th Annual Scientific Meeting: Abstracts 48 and 49. Presented March 25, 2012.

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