This Is MS Multiple Sclerosis Community: Knowledge & Support

** Question for Dr. S are you interested in doing a inspection with IVUS and not ballooning, purely to map any all veins for me?

I think the B-mode findings are more revealing after treatment.

** Is there any difference in outcome for people who have active lesions (Gadolinium Injection) on MRI at the time of PTA?

** I have not had active lesions on MRI over a 5 year period yet the lesions appeared in a 6 month space between MRI's and one on my cord was not seen two months ago. Is there a difference in outcomes if a person has stable MRI results at the time of PTA?
vascular system after PTA?

...

And also Sal will want to retire one day, when will that be, I will feel at a great loss at that time.
Nigel

A case of very early restenosis

On July 6, 2010 a 51 year old Canadian woman with RRMS was treated in Bulgaria by 10 mm high pressure balloon angioplasty for bilateral internal jugular stenoses and by 7 mm high pressure balloon angioplasty for azygous stenosis. She had remarkable improvements in motor, cognitive, and urinary functions. Balance improved. Fatigue was reduced. EDSS fell from 3.5 to 1.5.
This symptom improvement began to dissipate within a few months. By six months after the procedure, all benefits had disappeared except for fatigue and urinary urgency which no longer caused her discomfort.

In May 2012 she was re-treated by me because of weakness, and numbness in both lower extremities , and a lack of balance.

A 60% stenosis of the right internal jugular vein with intracranial reflux appeared to be the result of a septum (orange arrow) that was detected by IVUS. This was treated by larger balloon (16mm) high pressure (18 atmospheres)balloon angioplasty.



A 85% stenosis of the left internal jugular vein, shown by IVUS to be secondary to immobile valve leaflets, was treated by 16mm high pressure (13 atmosphere) balloon angioplasty.



Not shown, an azygous immobile valve was deteced in the anterior azygous arch and this was treated by a 10 mm balloon angioplasty inflated to 10 atmospheres. A "Nutcracker" syndrome of the left renal vein was also discovered and treated by self expanding stents.


Surprisingly she did not obtain any benefit from this treatment. Indeed she actually felt worse. Her balance deteriorated greatly.

She was observed for eight weeks but no improvements were detected. during that time. I decided to bring her back for a second look.

By that time re-stenosis had already occurred. The venograms lookef essentially the same as before the angioplasties in May. Angioplasties of both internal jugular veins was repeated.





Firstly, I am surprised that relief was achieved with such small balloons in Bulgaria. The vessel seems to look larger than that based upon IVUS. The 16 mm balloons I used certainly were not excessive.

Some say that if there is no response to angioplasty, then treatment of CCSVI is fruitless. . We will know in a couple of months whether that is correct. AT least now we know that failure to improve may result in early re-stenosis within days. or weeks.
I hope that some dialogue can be generated. It took longer to prepare this vignette than to perform the venography.

here is an update of my situation two weeks after the june 29th intervention :
-contrary to the may 4th intervention where i had not seen any improvement of my condition, i felt much better 24 hrs after the june 29th intervention , and still continue to feel much better after two weeks : better equilibrium , better legs strenght , better ability to walk ,brain fog significant diminution , sensitivity under my feet , fatigue sensation almost disappeard......
conclusion: A HUDGE IMPROVEMENT OF MY CONDITION 24 HRS AFTER THE INTERVENTION wich is STILL THERE AFTER TWO WEEKS.
THANKS TO YOU , THANKS TO YOU ....

I am sure that there are many patients with early restenosis that are thought of as failures.

This is fantastic news!

** Dr S have you ever had anyone that has not improved after a second IVUS inspection? This question comes to mind because of the Dr Rosa and Dr Flanagan insights that I have been posting. This 'could' be an amazing opportunity to have such a person do the study.
Regards Nigel

Did she show up clearly as having flow issues from the restenosis, using U.S.?

It's still early to declare a victory, but do you think ballooning twice over this short a time could turn out to make the thing last longer? I realize you would only do it for restenosis.

I did not think, I investigated