No Association Between Variations in Extracranial Venous Anatomy and Clinical Outcomes in Multiple Sclerosis Patients Over 5 Years

BMC Neurol. 2019 Jun 11;19(1):121. doi: 10.1186/s12883-019-1350-2.


Background: No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS).

Objective: This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients.

Methods: 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age- and sex-matched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (∆EDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed.

Results: No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ∆EDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486).

Discussion: This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients.

Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients.

Keywords: CCSVI; Disability progression; Extracranial; Longitudinal; Multiple sclerosis; Relapse rate; Variations in extracranial venous anatomy.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Azygos Vein / abnormalities
  • Brain / blood supply*
  • Case-Control Studies
  • Cerebrovascular Circulation
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Jugular Veins / abnormalities
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multiple Sclerosis*
  • Prospective Studies
  • Recurrence
  • Spinal Cord / blood supply*
  • Venous Insufficiency / epidemiology*