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Endovascular treatment of chronic cerebro spinal venous insufficiency in patients with multiple sclerosis modifies circulating markers of endothelial dysfunction and coagulation activation: a prospective study

Napolitano, Mariasantaa; Bruno, Aldob; Mastrangelo, Diegob; De Vizia, Marcellab; Bernardo, Benedettob; Rosa, Buonagurac; De Lucia, Domenicod

Blood Coagulation & Fibrinolysis: October 2014 - Volume 25 - Issue 7 - p 716–720
doi: 10.1097/MBC.0000000000000132

We performed a monocentric observational prospective study to evaluate coagulation activation and endothelial dysfunction parameters in patients with multiple sclerosis undergoing endovascular treatment for cerebro-spinal-venous insufficiency. Between February 2011 and July 2012, 144 endovascular procedures in 110 patients with multiple sclerosis and chronical cerebro-spinal venous insufficiency were performed and they were prospectively analyzed. Each patient was included in the study according to previously published criteria, assessed by the investigators before enrollment. Endothelial dysfunction and coagulation activation parameters were determined before the procedure and during follow-up at 1, 3, 6, 9, 12, 15 and 18 months after treatment, respectively. After the endovascular procedure, patients were treated with standard therapies, with the addition of mesoglycan. Fifty-five percent of patients experienced a favorable outcome of multiple sclerosis within 1 month after treatment, 25% regressed in the following 3 months, 24.9% did not experience any benefit. In only 0.1% patients, acute recurrence was observed and it was treated with high-dose immunosuppressive therapy. No major complications were observed. Coagulation activation and endothelial dysfunction parameters were shown to be reduced at 1 month and stable up to 12-month follow-up, and they were furthermore associated with a good clinical outcome. Endovascular procedures performed by a qualified staff are well tolerated; they can be associated with other currently adopted treatments. Correlations between inflammation, coagulation activation and neurodegenerative disorders are here supported by the observed variations in plasma levels of markers of coagulation activation and endothelial dysfunction.

aHematology Unit, Thrombosis and Hemostasis Reference Regional Center, University of Palermo, Palermo

bDivision of Endovascular and Vascular Surgery, Clinic GEPOS Telese Terme, Benevento, Italy

cFaculty of Medicine, University of Campobasso, Campobasso

dDivision of Neurology, Second University of Naples (SUN), Napoli, Italy

Correspondence to Napolitano Mariasanta, MD, Hematology Unit, Thrombosis and Hemostasis Reference Regional Center, University of Palermo, Palermo 90127, Italy Tel: +39 0916554405; fax: +39 0916554402; e-mail:

Received 9 January, 2014

Revised 24 March, 2014

Accepted 24 March, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins