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Chronic Cerebrospinal Venous Insufficiency (CCSVI)

Chronic cerebrospinal venous insufficiency (CCSVI) is a condition in which the normal drainage from the brain and spinal cord by the veins is impaired, due to the veins being narrowed. As a result, the blood flow may back-up into the brain and spinal cord. In 2009, Dr. Paolo Zamboni from the University of Ferrara in Italy published data that supported his idea that CCSVI might contribute to the development of multiple sclerosis (MS), with the hypothesis that the impairment in blood flow might lead to the inflammation seen in MS. In Dr. Zamboni’s studies, all of the patients with MS also had CCSVI.1

Subsequent studies

Subsequent studies have failed to find a connection between CCSVI and MS. There is now a growing body of evidence that suggests CCSVI is not linked with MS.2,3 In addition, there is controversy over how CCSVI is diagnosed. The diagnostic criteria set out by Dr. Zamboni are nonspecific and may account for people being diagnosed who actually don’t have anything wrong. The criteria were not based on validated methodology, and numerous groups that used the criteria from Dr. Zamboni found no evidence of CCSVI in people with MS.4

Treating CCSVI doesn’t affect MS

Two clinical trials have demonstrated that treating CCSVI has no effect on the progression of MS, leading more evidence to the idea that CCSVI does not cause MS. To treat CCSVI, doctors do an angioplasty procedure on the vein that drains from the head. During angioplasty, a thin tube is threaded to the vein and a balloon is inflated to push any plaque to the walls of the vein. In some cases, a metal mesh tube is put into the vein to keep it open.2,5,6

Written by Emily Downward | Last review date: July 2019.
  1. Zamboni P, Galeotti R, Menegatti E, et al Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis Journal of Neurology, Neurosurgery & Psychiatry 2009;80:392-399.
  2. CCSVI. National Multiple Sclerosis Society. Available at Accessed 4/17/18.
  3. Bhatia R, Abhishek, Prasad K. Chronic cerebrospinal venous insufficiency in Multiple Sclerosis: A note for caution. Annals of Indian Academy of Neurology. 2012;15(1):2-5. doi:10.4103/0972-2327.93266.
  4. Lee CJ. Chronic Cerebrospinal Venous Insufficiency: A Failed Concept. Vascular Specialist International. 2015;31(4):135-137. doi:10.5758/vsi.2015.31.4.135.
  5. Zamboni P, Tesio L, Galimberti S, et al. Efficacy and Safety of Extracranial Vein Angioplasty in Multiple SclerosisA Randomized Clinical Trial. JAMA Neurol. 2018;75(1):35–43. doi:10.1001/jamaneurol.2017.3825
  6. 6. Venous angioplasty and stenting. Saint Luke’s. Available at Accessed 4/17/18.