sbr487 wrote:Dr. S hope you are doing good!
I have just couple of questions.
Please ignore them if these have been already discussed (and I will understand and search around)
it is ok. i do not mind answering questions more than once. Hopefully my answers are consistent
- There have been some reports of people having worsening of symptoms for a brief period (this is post procedure) only to recover within a day or two. Can you bring up this point with your colleagues when you happen to participate in CCSVI discussions?
yes, this is true. There are many possible causes, including stress, dehydration and inadequate caloric intake prior to and during the treatment. But yes this is a subject that warrants analysis
- Generally, venogram is considered as a gold standard to study ccsvi. We have also discussed about how stenosis can be present without reflux and intervention is warranted only if reflux is seen.
I cannnot agree with that. I would not suggest that stenoses without reflux should not be treated. Reflux is best seen on ultrasound but nno test shows everything. If there is an outlet obstruction, i think it should be corrected except if the patient had no symptoms and no lesions on MRI.
There are also two types of reflux
ccsvi reflux where there is outlet obstruction and the blood is redirected upward toward the brain
incompetent valve reflux where blood from the heart is redrected up through valves that are not functioning to maintain flow down toward the heart. This results in short term upward flow but not redirection up into the brain
Does venogram also show reflux? If not, can one depend on it alone to make a decision about venous correction?
Thank you ...
it can show reflux when the contrast slowly drains after the dye is injected upward. The decision to treat is based on obstruction caused by stenosis and by valve abnormalities. The decision to continue dilatation may result from continuing to see reversal of flow