OBJECTIVE: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized 
by combined stenoses of the principal pathways of extracranial venous drainage, 
including the internal jugular veins (IJVs) and the azygous (AZY) vein, with 
development of collateral circles and insufficient drainage shown by increased 
mean transit time in cerebral magnetic resonance (MR) perfusion studies. CCSVI 
is strongly associated with multiple sclerosis (MS). This study evaluated the 
safety of CCSVI endovascular treatment and its influence on the clinical outcome 
of the associated MS.
METHODS: Sixty-five consecutive patients with CCSVI, subdivided by MS clinical 
course into 35 with relapsing remitting (RR), 20 with secondary progressive 
(SP), and 10 with primary progressive (PP) MS, underwent percutaneous 
transluminal angioplasty (PTA). Mean follow-up was 18 months. Vascular outcome 
measures were postoperative complications, venous pressure, and patency rate. 
Neurologic outcome measures were cognitive and motor function assessment, rate 
of MS relapse, rate of MR active positive-enhanced gadolinium MS lesions (Gad+), 
and quality of life (QOL) MS questionnaire.
RESULTS: Outpatient endovascular treatment of CCSVI was feasible, with a minor 
and negligible complication rate. Postoperative venous pressure was 
significantly lower in the IJVs and AZY (P < .001). The risk of restenosis was 
higher in the IJVs compared with the AZY (patency rate: IJV, 53%; AZY, 96%; odds 
ratio, 16; 95% confidence interval, 3.5-72.5; P < .0001). CCSVI endovascular 
treatment significantly improved MS clinical outcome measures, especially in the 
RR group: the rate of relapse-free patients changed from 27% to 50% 
postoperatively (P < .001) and of MR Gad+ lesions from 50% to 12% (P < .0001). 
The Multiple Sclerosis Functional Composite at 1 year improved significantly in 
RR patients (P < .008) but not in PP or SP. Physical QOL improved significantly 
in RR (P < .01) and in PP patients (P < .03), with a positive trend in SP (P < 
.08). Mental QOL showed significant improvement in RR (P < .003) and in PP (P < 
.01), but not in SP.
CONCLUSIONS: PTA of venous strictures in patients with CCSVI is safe, and 
especially in patients with RR, the clinical course positively influenced 
clinical and QOL parameters of the associated MS compared with the preoperative 
assessment. Restenosis rates are elevated in the IJVs but very promising in the 
AZY, suggesting the need to improve endovascular techniques in the former. The 
results of this pilot study warrant a subsequent randomized control study.