Is Chronic Cerebrospinal Venous Insufficiency a Cause of Multiple Sclerosis?

Recently, chronic cerebrospinal venous insufficiency ("CCSVI") was suggested as a new pathogenetic hypothesis in multiple sclerosis (MS) by Zamboni and colleagues: impairment of the cerebrocervical venous outflow by venous stenoses or other vessel obstructions should lead to stasis in cerebral veins with transendothelial extravasation of erythrocytes and subsequent inflammatory reactions in brain tissue. Based on this hypothesis and their own sonographic and angiographic data, therapeutic interventions by means of angioplasty were proposed as treatment for MS by Zamboni et al.. The "CCSVI" hypothesis, termed "the big idea" by Zamboni and colleagues, has caused substantial interest in the scientific community as well as amongst patients, caregivers, and the mass media. However, an independent confirmation of the data published by Zamboni et al. is lacking, while the number of negative studies with various techniques that question the "CCSVI" hypothesis is steadily increasing. The aim of this review is to delineate the "CCSVI" hypothesis and to summarise the data published by Zamboni et al. and subsequent investigators which mostly refute this hypothesis. According to the current evidence, there is no scientific plausibility of the "CCSVI" hypothesis and no further data that support this pathogenetic concept. Thus, there is no justification for any angioplastic therapies in MS patients.