Evaluation of Angioplasty in the Treatment of Chronic Cerebrospinal Venous Insufficiency (CCSVI) in Multiple Sclerosis

Not Applicable

Terminated

• Conditions: Multiple Sclerosis
• Interventions: Procedure: Angioplasty; Other: Observation

• Registration Number: NCT01201707
• Lead Sponsor: Community Care Physicians, P.C.

Brief Summary

The study is being done to determine if venous angioplasty is an effective treatment for chronic cerebrospinal venous insufficiency (CCSVI). In this condition, areas of narrowing or blockages are present in the internal jugular or azygos veins (veins which drain blood from the central nervous system) and these blockages may be associated with symptoms classically attributed to MS. Therefore, angioplasty may help to improve the symptoms associated with CCSVI and multiple sclerosis (MS). In this study, the investigators will evaluate the effectiveness of angioplasty in the treatment of CCSVI by comparing two the outcomes of two groups of patients: one group with CCSVI diagnosed on a venogram and treated with angioplasty and one group with CCSVI diagnosed on a venogram but not treated. The patients enrolled in this study, and the neurologist evaluating patients after the procedure, will not know whether or not they were treated with angioplasty.

Detailed Description

Not available

Study Timeline

• Study Start: 2010-08
• Study First Submitted: 2010-09-10
• Study First Submitted QC: 2010-09-14
• Study First Posted: 2010-09-15
• Primary Completion: 2013-09
• Study Completion: 2013-09
• Status Verified: 2013-11
• Last Update Submitted: 2013-11-25
• Last Update Posted: 2013-11-26

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 18

Inclusion Criteria

• Patients who are willing to comply with the protocol requirements and can be contacted by telephone
• Patients 18-60 years of age
• Patients with clinically definite multiple sclerosis by Polman criteria
• Patients with a history of MS as defined above with an EDSS between 3-6.
• Patients with a significant stenosis of the internal jugular or azygos vein on the basis of magnetic resonance venography or Doppler ultrasound.

Exclusion Criteria

• Patients with renal insufficiency based on an estimated GFR <45
• Patients with a known severe allergy to iodine or gadolinium-based contrast agents which cannot be adequately pre-medicated
• Patients with a known allergy to nickel
• Patients who pregnant
• Patients with a contraindication to anticoagulation or anti-platelet medication
• Patients with a contraindication to drugs used for conscious sedation during interventional procedures, including Versed and Fentanyl
• Patients with a history of deep venous thrombosis of the lower extremities
• Patients with occlusion of the right and left common femoral veins
• Patients who have had any changes in their disease modifying drug regimen for MS during the 6 months prior to enrollment in this trial. This would include the addition of any new medications, a change in the dosage of any medications, or the removal of any medications from a patient's drug regimen
• Patients with a life expectancy <18 months
• Patients who are currently enrolled or who plan to enroll in other investigations that conflict with follow-up testing or confounds data in this trial

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment of CCSVI with Angioplasty	Angioplasty	At the time of venography, these patients will have had a significant lesion (blockage) in the internal jugular and/or the azygos vein that will be treated with angioplasty.
Observation of CCSVI	Observation	At the time of venography, these patients will have had a significant lesion (blockage) in the internal jugular and/or the azygos vein that will not be treated with angioplasty. These patients will be observed after treatment and compared to those patients who received treatment.

Primary Outcome Measures

Name	Time	Method
Impact of CCSVI treatment on quality of life in patients with MS	24 Months	This will be assessed using the Multiple Sclerosis Quality of Life-54 (MSQOL-54), which is a health-related quality of life measure that combines generic and MS-specific items into a single, self-report questionnaire.

Secondary Outcome Measures

Name	Time	Method
Clinical significance of CCSVI in MS patients	24 months	This will be assessed clinically using annualized relapse rates, EDSS change and change in the timed 25 foot walk.
Safety of endovascular treatment of CCSVI	24 months	This is defined as the number and nature of any procedure-related adverse effects
Superiority of angioplasty to observation for treatment of CCSVI	24 Months	This will be assessed clinically using annualized relapse rates, EDSS change, and change in the timed 25-foot walk
Target vessel primary and secondary patency	24 months	Primary patency is the interval following the initial angioplasty procedure until a reintervention is performed to preserve patency. Secondary patency is defined as the interval following the initial angioplasty procedure until treatment of the vein is abandoned due to an inability to treat the original lesion
Incidence of CCSVI in patients with MS	0 Months	This will be assessed on the basis of the findings on diagnostic venography of the internal jugular and azygos veins, which is the initial procedure performed in these patients.

Trial Locations

Locations (2)

Image Care Latham; 🇺🇸 Latham, New York, United States

Albany Medical Center; 🇺🇸 Albany, New York, United States