Good evening.
Chronic cerebrospinal venous insufficiency is a syndrome characterized by flow blockages of the internal jugular and azygous veins system, with insufficient drainage from the brain. This syndrome has been recently inserted in guidelines in a consensus conference and published in the December issue of International angiology: a journal of the International Union of Angiology and vascular medicine. Venous pressure in the blocked and damaged jugular vein and the azygous vein was found to be significantly higher.
There are many other people who have observed this kind of syndrome and have correlated the association of this CCSVI with a neurodegenerative disorder called multiple sclerosis. We describe it in the original group of patients in which we found a very strong association in 100% of people, and in our experience we've found an association of 90%.
Dr. Zivadinov in the United States described an association of 60%, and the presence of CCSVI in 22% of other neurological disorders under normal controls. A group from Jordan described the prevalence of MS in 84% with 0% in controls. Dr. Simka, who is actually listening to us, found an MS prevalence of CCSVI in 90% of cases.
CCSVI was found to be associated with multiple sclerosis in different latitudes and in populations with different genetic backgrounds. I have found that the gold standard is catheter venography. It may very well defeat CCSVI, which is characterized by a narrowing wall malformation, with bypass activated through collateral circles. I have described this in the slide presentation sent two days ago.
As far as diagnosis is concerned, catheter venography is certainly the gold standard, but unfortunately it is an invasive technique. We have developed an echo-colour Doppler protocol, and I believe it is an ideal tool because it is not invasive and it is very useful for screening.
We also performed some tests in order to understand the reproducibility of this echo-colour Doppler protocol. We found it very useful if the physician, technician, or sonographer was trained in this, with some significant differences between trained and untrained operators.
As far as treatment is concerned, we applied simple, conservative angioplasty, and we described the effect of this treatment in a prospective pilot open-label study published last December.