DrSclafani answers some questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby Cece » Wed Jun 29, 2011 7:51 am

drsclafani wrote:When something is clearly phasic, i wonder when it is justified to treat.

Have you ever come across a CCSVI narrowing that you determined to be phasic yet considered it to be justified to treat?

I remember a patient of yours with an odd azygous, with a phasic narrowing.
Here it is:
www.thisisms.com/ftopicp-148962.html#148962

Would you treat this differently now than you did then?
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Postby mo_en » Thu Jun 30, 2011 4:15 am

Hi, Doctor and all.
In the imaginary case of an occluded jugular with a definite stenosis near the skull, would resolving that stenosis be in any way beneficial for the rest of the vein?
Could the angioplasty be performed though the other jugular and dural sinuses? Doctor, have you done, or are you planning to do, something like that? Thank you.
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Postby Nola » Thu Jun 30, 2011 5:42 am

Dr. Sclafani, if everyone could be so healthy as you, the whole world would be a happier place. Reading your posts helps me learn, gives me hope, and makes me laugh. Wishing you all the continued health and happiness. Thank you again for turning your life to people like us.
</div><div>Every moment of light and dark is a miracle. -- Walt Whitman</div><div>
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Postby drsclafani » Thu Jun 30, 2011 9:28 pm

Cece wrote:
drsclafani wrote:When something is clearly phasic, i wonder when it is justified to treat.

Have you ever come across a CCSVI narrowing that you determined to be phasic yet considered it to be justified to treat?

I remember a patient of yours with an odd azygous, with a phasic narrowing.
Here it is:
www.thisisms.com/ftopicp-148962.html#148962

Would you treat this differently now than you did then?


Cece, i dont recall doing so. It was during my first conversation with dr zamboni such a long time ago that he warned me about phasic narrowings. it led me to use IVUS from my very first procedure

i dont know whether he and, by extension, I are correct but something that is phasic seems to be physiological and unworthy of treatment.
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Postby drsclafani » Thu Jun 30, 2011 9:35 pm

mo_en wrote:Hi, Doctor and all.
In the imaginary case of an occluded jugular with a definite stenosis near the skull, would resolving that stenosis be in any way beneficial for the rest of the vein?
Could the angioplasty be performed though the other jugular and dural sinuses? Doctor, have you done, or are you planning to do, something like that? Thank you.


truly occluded veins are a really challenging entity. Hard clot, limited accessibility, strong resistance to catheterization, loss of intimal integrity, poor outflow and poor inflow, uncorrected or unrecognized causes of thrombosis, hypercoagulability are some of the things that must be overcome.


i digress....just having a momentary nightmare.....i will survive

stenoses near the skull typically represent hypoplasia or recanalized thromboses. They are another nightmare with not great options. it is not just angioplasty that is needed but also some method to maintain patency.

i have thought about traversing the dural sinuses to go from one side to another. At the current time, I consider this to be beyond my technical expertise. I would seek the assistance of a interventional neuroradiologist who has experience with this treatment. I would imagine that this would be unlikely to be successful.
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Postby Cece » Fri Jul 01, 2011 6:26 am

drsclafani wrote:i have thought about traversing the dural sinuses to go from one side to another. At the current time, I consider this to be beyond my technical expertise. I would seek the assistance of a interventional neuroradiologist who has experience with this treatment. I would imagine that this would be unlikely to be successful.

That seems wise.
Although I wish there was a interventional neuroradiologist convinced of the merits of ccsvi and knowledgeable of our particular issues. All in good tme, I suppose, and as the research comes in.

Any interesting cases lately?
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Postby drsclafani » Fri Jul 01, 2011 9:18 pm

Cece wrote:
drsclafani wrote:i have thought about traversing the dural sinuses to go from one side to another. At the current time, I consider this to be beyond my technical expertise. I would seek the assistance of a interventional neuroradiologist who has experience with this treatment. I would imagine that this would be unlikely to be successful.

That seems wise.
Although I wish there was a interventional neuroradiologist convinced of the merits of ccsvi and knowledgeable of our particular issues. All in good tme, I suppose, and as the research comes in.

Any interesting cases lately?


yes, some very interesting procedure.

but i have to focus of this symposium before i can spend the time to prepare these cases to show you.
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Postby Thekla » Sat Jul 02, 2011 5:36 am

Are you finding cause to place more stents now? i believe you mentioned the possibility a while back. A friend has just been retreated out west and had several stents placed. I'm awaiting more details from her as to where they were placed and whether it was restenosis or new stenoses or other problems. But I am hearing more about stents recently.
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Postby munchkin » Sat Jul 02, 2011 6:06 am

Dr.Sclafani

Have you had positive results treating restenosis due to scar tissue by ballooning or is this a situation that generally requires a stent?

Thank you for sharing your knowledge.
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Postby pklittle » Sat Jul 02, 2011 8:53 am

truly occluded veins are a really challenging entity. Hard clot, limited accessibility, strong resistance to catheterization, loss of intimal integrity, poor outflow and poor inflow, uncorrected or unrecognized causes of thrombosis, hypercoagulability are some of the things that must be overcome.


i digress....just having a momentary nightmare.....i will survive


Dr. Sclafani,
If a year has gone by since a vein has occluded, is it guaranteed that it is a hard clot? Does amount of time passed dictate the degree of density of the clot?
thanks
Pam
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Postby pklittle » Sat Jul 02, 2011 8:58 am

Dr. Sclafani,
Do you think Montel having the procedure and Dr. Oz tracking him for a special broadcast in the fall is going to open the floodgates in support of CCSVI research funding and treatments? Are you encouraged?
thanks again,
Pam
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Postby jgalt2009 » Mon Jul 04, 2011 11:40 am

drsclafani wrote:Lumbar hypoplasia seems very common among MSers of all types.


Dr. Sclafani,

Dr. Zamboni's original study documented 18 hypoplastic vein occurrences. He stated that 5 of 6 hypoplastic azygous veins were treated and "favorably responded". The study makes no mention of the other 12 hypoplasias.

1. Are you aware of any details regarding the other 12 hypoplastic vein occurrences (3 distal azy's, 1 lumbar, 4 IJV-l, 4 IJV-r) in Dr. Zamboni's study, and if they were treatable?

2. I know that hypoplasia is defined as an underdevelopment of a vessel or organ, and I am fairly sure that there are multiple ways that it can manifest itself;
a) can you tell me which manifestations are treatable, versus non-treatable?
b) specifically, what were the manifestations of the hypoplastic lumbar veins that you have encountered, and were you able to treat them?
c) if treatable, what was their patency?

Thanks for taking the time to answer our questions! Have a great 4th of July!
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Postby Cece » Mon Jul 04, 2011 1:30 pm

Some really good questions here today.
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Postby drsclafani » Mon Jul 04, 2011 7:40 pm

Thekla wrote:Are you finding cause to place more stents now? i believe you mentioned the possibility a while back. A friend has just been retreated out west and had several stents placed. I'm awaiting more details from her as to where they were placed and whether it was restenosis or new stenoses or other problems. But I am hearing more about stents recently.


Since I never put a stent in for more than one year, i would say that i have been placing more stents now. I have placed three stents to correct prior stenting issues related to prior procedures performed by others.
I have placed three stents in my patients where no stents were placed before.
one was a resistant stenosis, two were recanalizations through thromboses.

To be honest with you, i have never yet encountered a situation where i would put three stents.

treating the may thurner syndrome or the renal vein nutcracker syndrome requires stents to be effective. These i stent primarily.
Last edited by drsclafani on Mon Jul 04, 2011 8:02 pm, edited 1 time in total.
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Postby drsclafani » Mon Jul 04, 2011 7:44 pm

munchkin wrote:Dr.Sclafani

Have you had positive results treating restenosis due to scar tissue by ballooning or is this a situation that generally requires a stent?

Thank you for sharing your knowledge.


First of all, it is very difficult to tell if there is scar tissue from a venogram. Since most stenoses are valvular stenosis, i am not clear why scar tissue should be the problem, rather than restenosis due to valvular adhesion.

so lets not presume that restenosis is due to scar tissue. I think angioplasty is the first step. If successful the balloon lumen will improve.

If, however it is scar tissue, resistance to dilation would occur. This would lead to elastic recoil and angioplasty would fail, necessitating a stent
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