North52 wrote:Dr. Sclafani,
I would like to hear your thoughts on the risk of making an existing stenosis worse in the longterm. This is my major concern about proceeding with angioplasy. Anecdotally, we are seeing and hearing of impressive short term improvements in patients. What happens, however, in those patients that restenose? Do you think there is a significant possibilty that angio could worsen stenoses in the longterm? Although short term prognosis here may be excellent, longterm prognosis in patients may be worse. I know you cannot answer this question definitivley here, but I would appreciate your gut opinion based on your extensive experience.
Yes, north, I think that there is a risk of restenosis whenever one dilates a vein. That restenosis might be more difficult to treat as any scar tissue or intimal hyperplasia might result in more elastic recoil after angioplaty. Nonetheless treatment in the only reported trial demonstrated that about half the patients had no problems out to eighteen months. Others will require angioplasty repeated. Not ideal. nonetheless restenosis is better than untreated stenosis, (opinion). So why not stents to begin and reduce restenosis? NO EVIDENCE.
This study was reviewing stenosis of the subclavian and the inominate veins, bigger more central veins. The pathology is intimal hyperplasia in dialysis, the pathology in ms is a congenital malformation of valves and smaller veins. the patients with MS are younger, and are phsiologically healthier (except for MS) that patients with chronic renal failure, whose metabolic state is totally deranged.
Patients had repeat venography because they had a worsened symptomatic state. so only worsenings were studied
Actually the patients in this study were asymptomatic. patients with MS, well, have MS.
So while i do think that angioplasty increases potential for restenosis, we are treating for a reason and should address the restenosis when it occurs. Hopefully new stents will be designed that are better options by the time they are needed.
I mentioned this in another thread, but I thought I would ask you directly. To obtain immediate objective measures of improvement, have you thought of doing before and after visual evoked potentials and somatosensory potentials? I think this could be very interesting and might help to support the immediate improvments seen in some patients. My neuro-ophthalmologist is sceptical.
I have arranged to have evoked potentials done and will be reporting my results once I get them. I am booked for catheter venogram and possible angio next week somewhere in the USA.
So sad you must have a black market in treatment. Steathily seeking out doctors (hopefully of quality) but with no standards of care agreed upon or measure of outcome defined. I hope all the closeted doctors can come out soon and share their experiences as I do.
Yes, i think that electrophysiological data would be most interesting. How it fits is part of this era of discovery. Too bad you cant discover very much in the dark,