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    You are here : Home » MS Research News » New Discoveries » Chronic Cerebrospinal Venous Insufficiency (CCSVI) » CCSVI Studies

    CCSVI Studies

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    Chronic cerebrospinal venous insufficiency (CCSVI) in Multiple Sclerosis patients - Kuwait study

    Kuwait CCSVI Study Logo

    Chronic cerebrospinal venous insufficiency (CCSVI) in Multiple Sclerosis patients - Kuwait study

    Introduction - http://www.ccsvikuwait.com/uploads/Introduction.pdf

    AIM & OBJECTIVE:
     In Kuwait the MS patient is increasing and it is estimated about 3000 – 6000 patients. This program started in March. 2010, it is multidisciplinary approach, vascular diagnostic lab. doctor, vascular surgeon, and vascular intervention radiology, radiologist and neurologist.
     
    Our objective to diagnose MS patient with Chronic cerebrospinal venous insufficiency (CCSVI) and to evaluate them with Duplex scanning and magnetic resonance venography and to evaluate clinical and or radiological improvement of these cases after treating them with angioplasty with or without stent of the diseased affected part of the internal jugular vein,

    This method is a new application of a standard procedure that may be helpful in relieving some of the symptoms of MS patients with CCSVI and it was advocated in Italy, Poland and USA. In Kuwait we would like as usual to lead the way in the Gulf state and Arabian countries to study and assess the feasibility of such a new method of possible clinical improvement of some or all of the symptoms of MS patients which may help improve quality and functions of the patients and whether or not reach and meet our expectation, therefore we will do a pilot study of 100 patients and evaluate clinical improvement by a neurologist at 1, 3, 6, and 12 months. Colour Duplex scan at 1, 3, 6, 9, and 12 months intervals. MRV at 6 and 12 months intervals. MRI brain at 3, 6, and 12 months intervals. If the initial results of the study fulfilling our objectives then we will do more cases and continue the study for 1 year to include total 500 cases at least.

     

    SAMPLE SIZE:
     100 - 500 MS patients from all hospital.

    INCLUSION CRITIERA: 
     Patient:        with proven MS with positive Doppler and MRV (> 50% stenosis)
    Age:               18 and above

    Sex:               both males and females

    Nationality:   Kuwaiti

    Venue:           Mubarak Al Kabeer Hospital (other public hospitals will refer to Mubarak Hospital)


    EXCLUSION CRITIERA:
    Patient with sever co-morbid conditions (i.e. heart or lung disease or terminal of the disease MS)
    Patients younger than 18 years

    Pregnant females

    Patient with contrast allergies

    Patient with abnormal mental status

    Patient with normal Doppler and MRV testing(< 50% stenosis)

    Patients in whom the diagnosis of MS is not confirmed


    THE TESTS:

    Doppler ultrasound studies (VASCULAR Lab.)
    MRV (Magnetic Resonance Venography)
     

    THE PROCEDURE:  
     The angioplasty done by an Interventional Radiologist with assistance from a vascular
    surgeon. The patient is awake but is given mild anesthesia (50-100 % fentanyle).
    The procedure can be painful and the recovery can take a couple of
    months as the brain becomes acclimated to the new pressures of the new
    blood flows.

    The Accessory Nerve shares the same sheath as the jugular vein; therefore, there
    have been some instances where the Accessory Nerve (shoulder movement)
    has been damaged--time will tell if the damage is temporary or
    permanent.


    THE RESULTS: 
    The angiography may stop MS progression, BUT it cannot
    fix all symptoms, especially if axons have already been lost.
    However, some symptom improvements (anecdotally reported) are
    immediate, such as increased visual acuity and decreased (or
    eliminated) brain fog, tinnitus, and fatigue.

    MULTIDISCIPLINARY TEAM: 
     Vascular Surgery Unit
    Vascular Intervention Radiology

    Vascular Diagnostic laboratory

    MR Radiologist

    Anesthetist

    Neurologist


    NEUROLOGIST TASK:
    Referral of MS patients
    Document of severity of MS symptoms before the procedure with EDSS-FSS- and MSIS.

    Document of MS symptoms immediately after the procedure with EDSS-FSS- and MSIS.

    Follow up of patient symptoms at 3, 6 and 12 months


    SEQUENCE OF EVENTS:
    1.Neurology OPD (pre and post procedure)
    2.Vascular OPD (patient Data)
    3.Duplex
    4.MRV
    5.Admission & Venogram
    6.OPD follow up program  
    ◦Duplex

    ◦MRI

    ◦Neurology report

    ◦Treatment of possible stenosis


    MANAGEMENT OF COMPLICATIONS :

    •Stroke – ICU and neurologist management

    •Bleeding or thrombosis – ICU and medical or surgical intervention

    •Dissection or contrast extravasations – Re- ballooning and rarely use of stent 

     

    Management:

    •In the clinic check RFT, Coagulation profile,  RFT, CBC, Vit D deficiency and cross match I unit of blood
    •Admission as a day case (for 4-8 hours)
    •Patient Consent
    •Investigations (Duplex and MRV)
    • Plavix (2 tablets) & ASA before the procedure
    •Angioplasty depend on the findings
    •If angioplasty done then
    •     LMWH (Clexane) start 3hours after procedure for three days
    •     Plavix for 10 days post procedure on day 4
    •     ASA for one year post procedure on day one 
    • Remove compression bandgae in the groin next day  
    • Patient informed in case of groin bleeding or headache or flushed face to report to us   urgently ( for emergency Dr. Hussein Safar- tel 66789333)
    • Followed up in the vascular clinic after 3 days, 1 week, 1, 3,6, 9, 12 months.
    • Follow up with neurologist at 1, 3. 6. 12 months 

    Follow up:
    Out patient Clinic - Checking clinical improvement (neurologist and vascular)

    Duplex scanning initially after 1st months then every three months for one year- all date of Duplex testing is given to the patient (Dr. Abdul-Aziz Al Muzaini)


    MRI for MS at 3, 6, and 12 months then as required (for white spots), (Radiologist and neurologist)

    At 6 months and one year MRV (vascular)

    Follow up with neurologist report (neurologist)

    Possible complications

    Possible restenosis

    Possible re-intervention with balloon angioplasty

    Initial Results April 2010



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