Articolo del 19 gennaio 2014 preso da mediterranews.org
Nell’interessante articolo d’indagine sulla CCSVI della giornalista canadese Anne Kingston (http://mediterranews.org/2014/01/sclerosi-multipla-nel-2013-la-ccsvi-di-zamboni-si-e-sgonfiata/ ) sono stati evidenziati alcuni studi pubblicati nel 2013 contrari all’ipotesi del prof. Zamboni sulla correlazione tra CCSVI e sclerosi multipla.
Questi studi “negativi” curiosamente hanno trovato grande risalto nei media, che si sono subito affrettati a cercare di smontare la teoria di Zamboni con alcuni titoli piuttosto sprezzanti.
Scrive la Kingston che nel mese di agosto del 2013 è stata invece pubblicata sulla prestigiosa rivista scientifica Journal of Vascular Surgery (http://www.ncbi.nlm.nih.gov/pubmed/23948669 ) una ricerca italiana sulla sicurezza ed efficacia dell’angioplastica per il trattamento di CCSVI che non ha ricevuto praticamente alcuna menzione da parte dei media: gli autori hanno trovato blocchi venosi nel 98 per cento dei 1.200 soggetti con sclerosi multipla trattati!).
Forse basterebbe questo singolo studio a dimostrare che esiste una correlazione tra la CCSVI scoperta da Zamboni nel 2007 e la sclerosi multipla, ma purtroppo per alcuni non è così.
Chissà perché…
Abstract
OBJECTIVE:
Chronic cerebrospinal venous insufficiency (CCSVI) is a recently discovered syndrome mainly due to stenoses of internal jugular (IJV) and/or azygos (AZ) veins. The present study retrospectively evaluates the feasibility and safety of endovascular treatment for CCSVI in a cohort of patients with multiple sclerosis (MS).
METHODS:
From September 2010 to October 2012, 1202 consecutive patients were admitted to undergo phlebograpy ± endovascular treatment for CCSVI. All the patients had previously been found positive at color Doppler sonography (CDS) for at least two Zamboni criteria for CCSVI and had a neurologist-confirmed diagnosis of MS. Only symptomatic MS were considered for treatment. Percutaneous transluminal angioplasty was carried out as an outpatient procedure at two different institutes. Primary procedures, regarded as the first balloon angioplasty ever performed for CCSVI, and secondary (reintervention) procedures, regarded as interventions performed after venous disease recurrence, were carried out in 86.5% (1037 of 1199) and 13.5% (162 of 1199) of patients, respectively. Procedural success and complications within 30 days were recorded.
RESULTS:
Phlebography followed by endovascular recanalization was carried out in 1999 patients consisting of 1219 interventions. Balloon angioplasty alone was performed in 1205 out of 1219 (98.9%) procedures, whereas additional stent placement was required in the remaining 14 procedures (1.1%) following unsuccessful attempts at AZ dilatation. No stents were ever implanted in the IJV. The feasibility rate was as high as 99.2% (1209 interventions). Major complications included one (0.1%) AZ rupture occurring during balloon dilatation and requiring blood transfusion, one (0.1%) severe bleeding in the groin requiring open surgery, two (0.2%) surgical openings of the common femoral vein to remove balloon fragments, and three (0.2%) left IJV thromboses. The overall major and minor complication rates at 30 days were 0.6% and 2.5%, respectively.
CONCLUSIONS:
Endovascular treatment for CCSVI appears feasible and safe. However, a proper learning curve can dramatically lower the rate of adverse events. In our experience, the vast majority of complications occurred in the first 400 cases performed.
di Alessandro Rasman
Nell’interessante articolo d’indagine sulla CCSVI della giornalista canadese Anne Kingston (http://mediterranews.org/2014/01/sclerosi-multipla-nel-2013-la-ccsvi-di-zamboni-si-e-sgonfiata/ ) sono stati evidenziati alcuni studi pubblicati nel 2013 contrari all’ipotesi del prof. Zamboni sulla correlazione tra CCSVI e sclerosi multipla.
Questi studi “negativi” curiosamente hanno trovato grande risalto nei media, che si sono subito affrettati a cercare di smontare la teoria di Zamboni con alcuni titoli piuttosto sprezzanti.
Scrive la Kingston che nel mese di agosto del 2013 è stata invece pubblicata sulla prestigiosa rivista scientifica Journal of Vascular Surgery (http://www.ncbi.nlm.nih.gov/pubmed/23948669 ) una ricerca italiana sulla sicurezza ed efficacia dell’angioplastica per il trattamento di CCSVI che non ha ricevuto praticamente alcuna menzione da parte dei media: gli autori hanno trovato blocchi venosi nel 98 per cento dei 1.200 soggetti con sclerosi multipla trattati!).
Forse basterebbe questo singolo studio a dimostrare che esiste una correlazione tra la CCSVI scoperta da Zamboni nel 2007 e la sclerosi multipla, ma purtroppo per alcuni non è così.
Chissà perché…
Abstract
OBJECTIVE:
Chronic cerebrospinal venous insufficiency (CCSVI) is a recently discovered syndrome mainly due to stenoses of internal jugular (IJV) and/or azygos (AZ) veins. The present study retrospectively evaluates the feasibility and safety of endovascular treatment for CCSVI in a cohort of patients with multiple sclerosis (MS).
METHODS:
From September 2010 to October 2012, 1202 consecutive patients were admitted to undergo phlebograpy ± endovascular treatment for CCSVI. All the patients had previously been found positive at color Doppler sonography (CDS) for at least two Zamboni criteria for CCSVI and had a neurologist-confirmed diagnosis of MS. Only symptomatic MS were considered for treatment. Percutaneous transluminal angioplasty was carried out as an outpatient procedure at two different institutes. Primary procedures, regarded as the first balloon angioplasty ever performed for CCSVI, and secondary (reintervention) procedures, regarded as interventions performed after venous disease recurrence, were carried out in 86.5% (1037 of 1199) and 13.5% (162 of 1199) of patients, respectively. Procedural success and complications within 30 days were recorded.
RESULTS:
Phlebography followed by endovascular recanalization was carried out in 1999 patients consisting of 1219 interventions. Balloon angioplasty alone was performed in 1205 out of 1219 (98.9%) procedures, whereas additional stent placement was required in the remaining 14 procedures (1.1%) following unsuccessful attempts at AZ dilatation. No stents were ever implanted in the IJV. The feasibility rate was as high as 99.2% (1209 interventions). Major complications included one (0.1%) AZ rupture occurring during balloon dilatation and requiring blood transfusion, one (0.1%) severe bleeding in the groin requiring open surgery, two (0.2%) surgical openings of the common femoral vein to remove balloon fragments, and three (0.2%) left IJV thromboses. The overall major and minor complication rates at 30 days were 0.6% and 2.5%, respectively.
CONCLUSIONS:
Endovascular treatment for CCSVI appears feasible and safe. However, a proper learning curve can dramatically lower the rate of adverse events. In our experience, the vast majority of complications occurred in the first 400 cases performed.
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