page_title: Paolo Zamboni
section_title: Chronic Cerebrospinal Venous Insufficiency – CCSVI
hierarchical_section_title: Paolo Zamboni / Chronic Cerebrospinal Venous Insufficiency – CCSVI
caption_attribution_description: English: Treatment of CCSVI - endovascular angioplasty, balloon dilatation of stenosis of the left internal jugular vein.
context_page_description: Paolo Zamboni is an Italian doctor included among the Top Italian Scientists. He is full Professor and Director of the School of Vascular Surgery at the University of Ferrara in Italy.
  He is known to have discovered, identified and described a vascular disease called chronic cerebrospinal venous insufficiency strongly related with multiple sclerosis and other neurodegenerative diseases such as Ménière and Parkinson.
context_section_description: Chronic Cerebrospinal Venous Insufficiency is characterized by defective venous drainage from the brain and spinal cord as a result of outflow obstruction in the extracranial venous system, mainly caused by stenosis, defective valves, hypoplasia, and or compression of the Internal jugular vein, azygos vein. CCSVI was initially brought forth as possible contributing factor to the pathogenesis and clinical manifestations of multiple sclerosis and of other neurodegenerative diseases. Indeed, in 2009 he claimed to have found this vascular condition in an unblinded preliminary study that in over 90% of the participants with multiple sclerosis there were problems in veins draining their brain. He also noted a high level of accumulation of iron deposits in the brain, presumably due to limited blood outflow.
  Studies have demonstrated a relationship between tissue iron accumulation and the inflammatory changes associated with chronic venous insufficiency, so the presence of iron may contributes to the neurodegeneration of brain.
  Nowadays evidence already exists for reduced perfusion in patients with MS that in turn contributes to neurodegeneration. Current data suggests that defective extracranial venous drainage reduces the perfusion of brain parenchyma. Attention has been drawn to the role of abnormal venous drainage in multiple sclerosis in the form of CCSVI. Recent quantitative studies on cerebral venous drainage demonstrate that flow in the jugular veins is linearly related to global brain perfusion.
  According to Zamboni some symptoms of multiple sclerosis in his own wife as well as in 73% of his patients were abated after an endovascular procedure to open these veins.
  The theory was controversial. The National Multiple Sclerosis Society had said that, while "there is not yet enough evidence to conclude that obstruction of veins causes MS," that "[Zamboni's] hypothesis on CCSVI and its corrective treatment is a path that must be more fully explored and one that we are supporting with research funding." Since 2010, there has been more research that disputes the Zamboni theory.
  On November 28, 2017, Zamboni admitted that balloon venous angioplasty cannot be indiscriminately applied to all patients affected by relapsing remitting MS with associated CCSVI on the basis of "a double-blind randomized controlled trial versus sham therapy. A further expanded analysis of the same double blinded randomized sham controlled trial (Brave Dreams)  showed that venoplasty decreases new cerebral lesions at 1 year in a wider patients population which includes also secondary progressive MS. Further post hoc analysis demonstrated the need to select patients. Patients appropriate for venoplasty, according to the morphology of venous malformation, were more likely to be free from accumulation of new cerebral lesions at MRI.
caption: Balloon dilatation of stenosed jugular vein in a MS patient.
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