nicknewf wrote: drsclafani wrote:
nicknewf wrote:Dr. Sclafani,
Since your symposium, have the physicians who participated started to fall in line around a common treatment protocol... are most sharing information between each other - or are most people practicing in silos?
the promise by SIR (society of interventional Radiology) to create some guidelines is helpful and cannot come soon enough...
in the meantime, you have to start asking about experience, and outcomes from the treating physicians and not get too desparate for anyone who offers treatment.
Dr. Sclafani, thanks for your response, and enjoy yourself in China. As a follow up question. I have just read Mehta's approved trial, and I am concerned that they are treating stenosis rather than valves. The more successful (based on data at your symposium) practitioners seemed to be focusing on the valvular issues and observing that in some cases, the stenotic lesions resolved once the valve was corrected (I was never sure if the stenosis were downstream or upstream from the valve problems, but I thought downstream with collateral formation and bulging upstream).
some semantics are necessary:
i differentiate narrowing that may be caused by many things, some of which are not permanent or abnormal from stenosis which implies to me a fixed narrowing. This is very important concept. Valves that do not open because they are malformed lead to stenoses. Scar tissue or atherosclerosis causes stenosis of arteries and dialysis grafts. Narrowing might be due to the fact that there is little blood filling a vein or due to a higher pressure structure like the carotid artery indenting it. If you fill the vein it distends from a physiological narrowing but will not if it is malformed vein.
This is a difficult perceptual concept and does lead to confusion. Sorry but true. and you are not alone in this confusion. Many doctors also are confused
Do you know if Mehta plans to treat the stenosis by first treating the valve (cutting the valve) and then doing upstream balloon angioplasty on stenosis at other locations only if they do not resolve?
sorry, i do not
My wife will be one added to the list of pioneer patients this month, and I want to be able to have a sensible conversation with her and her physician pre-treatment about risks, protocols. I have met her Dr. and trust him to do an excellent job; but he's obviously less than a year at this too!
Thanks again for everything you do here. The peace of mind you help provide is solace.
i think that there are very very few people who are indeed fully experienced in ccsvi or liberation. I would include myself among them. Dr. Zamboni would consider anyone who has not performed 50 procedures to still needing experience.
thus your wife is a pioneer