DrSclafani answers some questions

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

Postby HappyPoet » Fri Aug 19, 2011 1:21 pm

For those who might have missed this post of 8/8/11:

HappyPoet wrote:Welcome, Dr. Tucker,

Thank you for visiting TIMS! :)

~~~~~~~~~~~~~

Below are links to Dr. Tucker's excellent presentation, From Stenoses to Fatigue and Scleroses:

Part 1 of 3
http://www.youtube.com/watch?v=WriNVSNy ... re=related

Part 2 of 3
http://www.youtube.com/watch?v=g07XPAA_ ... re=related

Part 3 of 3
http://www.youtube.com/watch?v=ABRD5P8Y ... re=related

http://www.thisisms.com/ftopicp-173021.html#173021
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Postby Cece » Fri Aug 19, 2011 2:29 pm

HappyPoet wrote:Here's a link to an article that discusses the idea of using IVUS to measure pressure waves in coronary arteries, and some of the broader ideas seem like they might also relate to veins:

http://www.cathlabdigest.com/articles/C ... confounder

This is what Dr. Sclafani was just talking about in this most recent case, isn't it? Catheter-induced vasospasm.

Great links, HappyPoet, both this one and the Dr. Tucker vids.
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Postby HappyPoet » Fri Aug 19, 2011 4:07 pm

Cece wrote:
HappyPoet wrote:Here's a link to an article that discusses the idea of using IVUS to measure pressure waves in coronary arteries, and some of the broader ideas seem like they might also relate to veins:

http://www.cathlabdigest.com/articles/C ... confounder

This is what Dr. Sclafani was just talking about in this most recent case, isn't it? Catheter-induced vasospasm.

Yes, Cece -- the article shows how DrS is on the ball to suspect vasospasm (which I meant to say originally, so thank you!). :)
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Postby Cece » Sun Aug 21, 2011 7:51 pm

So is drsclafani officially away on vacation?
I may need a DSASQ 12-step program.
"Hi, my name is Cece, and...."
:)
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Postby MikeInFlorida » Mon Aug 22, 2011 4:35 am

Cece wrote:So is drsclafani officially away on vacation?
I may need a DSASQ 12-step program.
"Hi, my name is Cece, and...."
:)
LOL... me too. I sent him some pics of the patient's port implant and removal, but I may have been too late for him to finish the discussion prior to departure. Anyway, I hope he has a great vacation!

I also made available to Dr. S. a CT scan after implant, but my untrained eye could not pick up the port. Obviously it was there, but I suppose it takes some experience to know how it displays, and follow it from slice to slice.

Also, I watched ttucker's 3-part video. Well done, Dr. T., I have forwarded it to many friends, and highly recommend it here.
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Postby MikeInFlorida » Mon Aug 22, 2011 5:26 am

ttucker wrote:MikeinFlorida
If you haven't seen it yet you might want to watch my 3 part Youtube called "From Stenoses to Fatigue and Scleroses".

I watched it. Very well done! Thank you for all the effort you put into this. I have always believed that increased static pressure was facilitating extravasation, but static pressure increases should show linear plaque distribution. Your standing wave hypothesis provides viable reasoning for the observed plaque geography.

I would also like to see explored the impact of the standing waves on the physiochemistry (esp. expression of surface adhesion molecules) of the lymphocytes.
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Postby DougL » Wed Aug 24, 2011 5:48 am

Cece wrote:So is drsclafani officially away on vacation?


I will be in wilderness and unable to read or respond to any email.
If this is a patient inquiry, please email zzz@zzz-zzz.com.
If this is personal, please hold the thought and email me after August 29.

--
Salvatore JA Sclafani MD
Chief Medical Officer for CCSVI
American Access Care Physicians

Professor of Radiology, Surgery and Emergency Medicine SUNY Downstate Medical Center
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sigmoid sinus?

Postby Donnchadh » Wed Aug 24, 2011 7:28 am

The following excerpt was from Dr. Sclafani:

QUOTE:

The catheter was placed in the left transverse sinus.
Dural sinus venography looked like this:

(image was in original post)

These images show that the transverse sinus and the sigmoid sinus had normal diameters. However there was a prominent connection between the transverse sinus inside the skull and the vertebral vein and posterior cervical branches on the outside. These vessels are connected by a very large emissary vein traversing across the skull via the hypoglossal canal. This canal is usually a very small opening in the skull but in this patient it is exceedingly large. I think this suggests that a long standing (perhaps congenital) outflow obstruction of the internal jugular vein has existed

UNQUOTE.

My question is about the sigmoid sinus. I was told that I have bilateral stenosis in this region by three different IR's but this area is untreatable. Is it now possible to treat the sigmoid sinus?

Donnchadh
Kitty says, "Take that, you stenosis!"

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Postby Cece » Wed Aug 24, 2011 8:09 am

I didn't know or didn't remember you had that, Donnchadh. One of my fears going into CCSVI testing and treatment was that I'd have something untreatable. (The other fear was that I'd be left with something untreatable, like an occlusion, afterwards.)

Dr. Sclafani is away on vacation, so we won't get an answer quickly.

Did any of the IRs say what sort of blockages they were? Malformation or clot or....?
Dr. Sclafani has consulted or sent a patient to a neurointerventional radiologist for further testing about a sinus abnormality, even though the neurointerventional radiologist is not convinced that CCSVI has merit. My understanding is that this is not an area that the IRs are treating, but that it is worth seeking an opinion from a neurointerventional radiologist.

This past ISNVD added our physicists (Dr. Tucker, Dr. Beggs) to the circle, maybe the next one will bring neuro-opthalmologists and neurointerventional radiologists and more of the specialists that we need for this multidisciplinary disease.
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Postby NZer1 » Wed Aug 24, 2011 4:48 pm

There has been discussion on other threads about the enlargement of skull drainage passages that is cased by reflux or reverse waves from stenosis further down. I asked Dr. S about this recently on this thread and he said that so far he had not noticed it to be a common problem.
I do wonder though if it was suspected what would be seen.
Regards Nigel
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Postby newlywed4ever » Fri Aug 26, 2011 5:31 pm

Dear Dr Sclafani - please avoid Irene; stay safe! Same sentiment to all those on the east coast...
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Postby 1eye » Sun Aug 28, 2011 9:16 am

I will be in wilderness and unable to read or respond to any email.
If this is a patient inquiry, please email zzz@zzz-zzz.com.
If this is personal, please hold the thought and email me after August 29.


Hope you went somewhere it's not raining!
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Postby NZer1 » Mon Aug 29, 2011 2:53 am

Hi Everyone, I have been talking about the reverse waves and have wondered about the effects of other regions of the body when there is reverse flows.
I am assuming that the blood returning to the heart is, in concept in a pool, and that if there is fluctuations in any system for any reason that pool will 'move' within the veins.
The thought I had was regarding leg veins. Then I thought more about what understanding there is for any movements and functions.

* If the holding of ones breath and unblocking your ears for instance, vasavalar move, directs blood away from the heart, does that mean that many actions in everyday life will send blood back into the brain of someone with CCSVI?

* Is there any way of testing what blood movement is normal?

* Can its transit be tested between normals and PwMS for instance?

* If we are not aware of what the blood ebbs and tides are, then opening veins is premature?
* The main interest I have is what happens when the lumbar veins are refluxing?

The source of refluxing blood could be from other sources, such as leg veins, abdominal compression's, and things I have no understanding of.
Regards Nigel
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Postby drsclafani » Thu Sep 01, 2011 8:14 pm

NZer1 wrote:Seeing the comment about scar tissue reminds me.
If a person had been over ballooned would this be evident and obvious, I see that when scar tissue is present it creates more problem for you.
There was a time when large balloons were touted as being the best option for busting valves, I guess there is poetic license with the term 'large'. I remember watching Dr. Tarqins videos, thinking that the idea of 'big is good' is risky without knowing what the vein can cope with before damage occurs that will be problematic in future.

Is it possible the vein wall is 'diseased' and that that will also allow the BBB breach that is spoken of, the area would need to be within the skull I guess, so it would not be from PTA?

It is the term 'diseased' that I am interested in and how to identify it, and where it is found and why?

Is the vein wall the problem when over ballooned or is it the remains of the valve and anulus that remain present the problem?

Is it possible to identify when there is scar tissue? IVIS?

and how do you know when there is vein disease?

Thanks again,
Nigel


We can see niclely the intima and media with ultrasound. But we really dont have a great way of determining scar tissue. We can see narrowing but we cannot see much more than thickening . We can see dilation caused by weakness.
IVUS is most useful in assessing the perivenous inflammatory condition by seeing strongly echogenic responses surrounding a narrowed vein.
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Re: ccsvi in the legs

Postby drsclafani » Thu Sep 01, 2011 8:28 pm

Robnl wrote:Hi Doc,

see
http://iamsickofms.blogspot.com/2011/08 ... swers.html

Globally, i'm in the same situation as Ginger.....i'm going to check the leg veins.

What do you think about ccsvi in 'other' places??


i do not think that CCSVI is a risk factor for varicose veins and deep vein disease of the lower extremities.

Lower extremity venous disease is so common.

J Vasc Surg. 2004 Oct;40(4):650-9.
Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France.
Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A.
Source
University Research Center of La Léchère, Grenoble, France. patrick.carpentier@ujf-grenoble.fr
Abstract
OBJECTIVES:
The goals of this study were to document the prevalence of varicose veins, skin trophic changes, and venous symptoms in a sample of the general population of France, to document their main risk factors, and to assess relationships between them.
METHODS:
This cross-sectional epidemiologic study was carried out in the general population of 4 locations in France: Tarentaise, Grenoble, Nyons, and Toulon. Random samples of 2000 subjects per location were interviewed by telephone, and a sub-sample of subjects completed medical interviews and underwent physical examination, and the presence of varicose veins, trophic changes, and venous symptoms was recorded.
RESULTS:
Prevalence of varicose veins, skin trophic changes, and venous symptoms was not statistically different in the 4 locations. In contrast, sex-related differences were found: varicose veins were found in 50.5% of women versus 30.1% of men ( P < .001); trophic skin changes were found in 2.8% of women versus 5.4% of men ( P = NS), and venous symptoms were found in 51.3% of women 51.3% versus 20.4% of men ( P < .001). Main risk factors for varicose veins were age and family history in both sexes, and pregnancy in women. Female sex was a significant factor only for non-saphenous varicose veins. Varicose veins, age, and pitting edema were the most significant risk factors for trophic skin changes. The risk factors for venous symptoms were female sex, varicose veins, and prolonged sitting or standing. A negative relationship with age was found in women.
CONCLUSION:
Our results show a high prevalence of chronic venous disorders of the lower limbs in the general population of France, with no significant geographic variations. They also provide interesting insights regarding the association of varicose veins, skin trophic changes, and venous symptoms.


One should not be surprised that it would be seen in a patient with ccsvi. The incidence of May thurner syndrome is no more common in patients with ccsvi that in healthy controls.

The bottom line is that if you have symptoms of venous disease in the legs, have it looked at by a competent specialist in this area.
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