della SocietÓ Italiana di Cardiologia

Roma, 10 – 12 dicembre 2011

    VASCULOPATIE PERIFERICHE E ICTUS                                                                                                                                      957

data analysis of the chronic cerebro-spinal venous insufficiency in patients with multiple sclerosis: new disease classification


Sandro  Mandolesi (a), Francesco Ciciarello (a), Azzurra Marceca (a), Dimitri  Mandolesi (a), Aldo Galeandro (a), Ettore Manconi (b), Marco Matteo Ciccone (c), Francesco Fedele (a)


(a) Dipartimento Scienze Cardiovascolari,Respiratorie,Geriatriche e Nefrologiche,Univ.La Sapienza,Roma, (b) Dipartimento Scienze Cardiovascolari, UniversitÓ di Cagliari, (c) Dipartimento Scienze Cardiovascolari, UniversitÓ di Bari




Background: Multiple Sclerosis (MS) is an autoimmune neurological disorder and it’s characterized by demyelination of the central nervous system. There are several different clinical types: Relapsing Remitting Multiple Sclerosis (RR); Secondary Progressive Multiple Sclerosis (SP); Primary Progressive Multiple Sclerosis (PP). A new nosological vascular pattern recently identified, defined as Chronic Cerebro-Spinal Venous Insufficiency (CCSVI), has been associated with the MS by more scientific studies. Aim: to analyze a large sample of patients affected by MS following Zamboni’s five ultrasound criteria by using a hŠmodynamic morphological map (HMM). The HMM is a new digital computerized technological paper created by us, that enables us to see the actual incidence of CCSVI and to perform a statistical evaluation of the lesions in our patients.                       

Materials and Methods: we investigated 552 patients affected by MS and diagnosed them according to the revised McDonald criteria (women 60,3 %, n=333; men 39,7 %, n=219; mean age 42,9 years; mean Expanded Disability Disease Score, EDSS: 4). The duration of the disease was on average 6 years. We studied also a control group of 120 normal subjects(women 66,6%, n=80; men 33,4 %, n=40; mean age 45 years).The study data has been obtained following a protocol with Zamboni criteria using a non-invasive study of cerebral venous return with Echo-Color-Doppler (MyLab Vinco ECD System, Esaote) equipped with 2.5 and 7.5–10 Mhz transducers. We focused on the detection of five Zamboni Criteria (C):C1- Reflux in the Internal Jugular Veins (IJVs) and/or Vertebral Veins (VVs) in sitting and supine posture;C2- Reflux in the Internal cerebral veins(DCVs); C3- High-resolution B-mode evidence of proximal IJV stenoses;C4- Flow not Doppler detectable in the IJVs and/or VVs; 5- Reverted postural control of the main cerebral venous outflow pathway (ΔCSA). The subjects have been investigated in both supine and sitting positions (0░and 90░) and the anomalies identified by the ECD examination were then written on HMM (a digital computerized technology paper where the operator inserts symbols that correspond to the five Zamboni criteria). Results: our data demonstrated a significant incidence of CCSVI in the MS (positive were 83% with mean EDSS=5 and negative were 17% with mean EDSS=3) contrary to control group (positive 25% and negative 75%). The Criteria distribution in the positive group was C1=49,3%;C2=56%;C3=72%;C4=61,1%; C5=12,2%; in the negative was: C1=31,9%; C2=17%;C3=19%;C4=18,1%;C5=2,1%.The statistical comparison study between the two groups of patients demonstrated that the criteria have a significant incidence in the positive group (p<0,01) and the EDSS have p<0,01.Conclusion: the HMM allows us to register the anomalies identified by the ECD examination in a few seconds; it facilitates statistical analysis of the CCSVI criteria. Our data demonstrated that the C2, the C3 and the C4 are more present in the positive CCSVI population versus negative. Instead, in the negative population, the C1 is more represented in comparison to the other criteria. So, whereas the our new criteria: frontal compression of a normal vein (IJVs and/or VVs), we identified 3 new types of CCSVI: Type 1 includes patients with Block of IJVs and/or VVs; Type 2: patients with Compression of  IJVs and/or VVs; Type 3: patients with Block of  IJVs and/or VVs, Compression of  IJVs and/or VVs.






NOTA: il numero di pagine di questa anteprima pu˛ non corrispondere con quella dell’abstract.