DrSclafani answers some questions

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

Re: DrSclafani answers some questions

Postby Anonymoose » Tue Apr 09, 2013 8:29 am

drsclafani wrote:
Nigel, I've come to the conclusion that Dr. Arata needs the ever elusive superIVUS that has been discussed here before. (A new improved IVUS intravascular ultrasound that is 10 time sharper than old IVUS.) He is ballooning the area of the valves, as are all the IRs, although he is ballooning valves that appear normal, which is different than all IRs. Normal healthy valve leaflets are too thin to show up on regular IVUS. With the new better IVUS, we could get a moving image of these supposedly normal valve leaflets. Either they are indeed normal or they are thickened as is seen in MS or they might be dysregulated so that the flapping is not in sync. This dysregulation of valve leaflet motion could be a result of the dysautonomia and could contribute to flow disruption, which could explain the improvement Dr. Arata has seen when these valves are ballooned. It is at least a way to investigate but the new IVUS is needed.

OK Dr. Sclafani can have his thread back now. Sorry for too many posts!

Do the thickened valves flap around or cause the vein to vacillate on a point? If they do, I wonder if they couldn't disrupt nerve transmissions the same way an artery can when it compresses a nerve. Maybe that's why ballooning functioning valves works...they'd have to be thickened or abnormal in some way though. If this is the case, then it would be the removal of a chronic mechanical stimulation rendering some of the PTA improvements (rather than the addition of mechanical stimulation during the ballooning event).


the thickened valves are pretty much immobile in a fixed closed position. That is what is causing a stenosis.
what do you mean by an artery compressing a nerve. Aneurysms compress nerves but give me an example of an artery that compresses a nerve.

veins are highly complant structures of very low pressure. The idea that they could compress a nerve make no sense to me.


Here's an example of neurovascular compression.
http://radiology.rsna.org/content/early ... 00477.full

I no longer have the misguided idea that veins can compress a nerve (ty)...I'm working with a new misguided idea. Could the higher frequency vibrations of the thickened (if they behave like stiffened/calcified) valves travel through to the vagus and impact nerve transmission or tone?? Would it be a bit like a tuning fork on the nerve?? (I don't think this would be a major player in PTA...but maybe a sidenote, something to look for if room for improvement remains? Trying to make sideways sense of Arata's focus on the vagus at the valves.)

Edit:
Vibration and vasospasm??? chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic20130-75.html#p207530 When you balloon valves, do surrounding stenosi typically resolve? Is zamboni having better results with his valve clipping tool?

Edit 2:
Could some restenosi be caused by leftover valve parts starting to vibrate again?


The valve IS the stenosis. The surrounding vein is almost always normal. the "vibrations" are not like your power toothbrush. They arent vibrating like that. I think oscillation might be a better term, but lots of our body vibrate, the hairs in our nose, the valves ini the heart and other valves as well,
i think this vibration thing is another out of control urban legend waiting to happen :sad:

The restenosis is just adhesions at the sites where the valve was torn or stretched.

Thanks Dr. S,
I thought there was a difference between a bad valve and a stenosis. I thought wrong. :)

There's absolutely no evidence to support the vibration idea. Plus, its just not as exciting as the stolen organ black market stories. How could it go urban legend?? I'm not even close to convinced. It was just a line of questioning about a possibility (which seems not to be a possibility).
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Re: DrSclafani answers some questions

Postby newlywed4ever » Tue Apr 09, 2013 4:44 pm

I was tempted to see if Dr Arata could get through my occluded LIJV and am ever grateful for this thread. I'm still looking for answers but will wait for the Dr. Sclafani "stamp of approval" before pursuing new avenues....
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Re: DrSclafani answers some questions

Postby NZer1 » Tue Apr 09, 2013 5:11 pm

Dr S is there any way of knowing if atherosclerosis is present in the patients you treat?

You didn't answer my question about the ET-1 awareness by IR's, btw?

I ponder that if MS patients have a 224% higher level than 'normals' then it may have involvement in outcomes of PTA because ET-1 is linked to atherosclerosis, is there an influence on things like re-stenosis incidence?

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Re: DrSclafani answers some questions

Postby NZer1 » Tue Apr 09, 2013 7:27 pm

Dr S, Hi, me again!

If ET-1 is crossing the BBB because of 'Franz Schelling' back jets, or Rosa alignment issues or Zamboni CCSVI reflux and travelling through the brain GM and WM lesions and mixing with the CSF and spreading through the brain with the concentration of ET-1 is increasing, will that cause symptoms and atrophy and things like Thalamas link issues.

Could be a cascade of issues?

A host of disease types could have this mechanism and that could be the reason for similar symptoms across many de-generative diseases?

It might also explain why PTA outcomes vary because of the ET-1 levels that either do or don't cross the BBB post PTA, a sealing effect?

Back to bed too much thinking ;)
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Re: DrSclafani answers some questions

Postby tzootsi » Wed Apr 10, 2013 7:00 am

Hi Dr,

I recently watched your video from the 2012 ISNVD conference, it was great. I'm not seeing anything from Krakow. Will there be any videos?
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Re: DrSclafani answers some questions

Postby HappyPoet » Wed Apr 17, 2013 12:04 pm

Hi DrS, I hope you're doing well.

Edit: Repeat post.
Last edited by HappyPoet on Mon Apr 22, 2013 4:38 pm, edited 1 time in total.
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Re: DrSclafani answers some questions

Postby Cece » Wed Apr 17, 2013 1:21 pm

SIR conference was this weekend, wasn't it? Hope that went well.
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Re: DrSclafani answers some questions

Postby JohnAm » Sun Apr 21, 2013 12:40 pm

Dr S,

An acquaintance attended a seminar at the local university hospital last month and the dr/researcher cardiologist talked about NIRS as a new technique or modality in addition to IVUS.
Could NIRS be of value in your work and CCSVI armamentarium?


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Re: DrSclafani answers some questions

Postby drsclafani » Sun Apr 21, 2013 8:17 pm

Cece wrote:SIR conference was this weekend, wasn't it? Hope that went well.

cece
it was a good meeting. I am back and will answer questions and show some interesting observations as soon as i can finish creating the case.

i gave a talk on early restenosis and "non-responders" and how to address the many causes of these. It wasnt recorded that i know but i am trying to learn how to created my own lecture on line

an old dog trying to learn new tricks
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Re: DrSclafani answers some questions

Postby CureOrBust » Mon Apr 22, 2013 3:31 am

drsclafani wrote:i gave a talk on early restenosis and "non-responders" and how to address the many causes of these.
oooo.. i'd be very interested in this video.
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Re: DrSclafani answers some questions

Postby Cece » Mon Apr 22, 2013 10:26 am

It wasnt recorded that i know but i am trying to learn how to created my own lecture on line

maybe Wheelchair Kamikaze would have some tips?
Dr. Sclafani, vlogger!
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Re: DrSclafani answers some questions

Postby Cece » Mon Apr 22, 2013 10:31 am

CureOrBust wrote:
drsclafani wrote:i gave a talk on early restenosis and "non-responders" and how to address the many causes of these.
oooo.. i'd be very interested in this video.

With nonresponders in quotations, I think this is probably not about true nonresponders who had the procedure done to perfection but didn't result in any change in their symptoms. Instead it would be patients who seem to be nonresponders but whose procedure wasn't thorough enough or the balloons not appropriately sized and so there is hope for a more optimized procedure to turn them into responders.
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Re: DrSclafani answers some questions

Postby NZer1 » Mon Apr 22, 2013 1:19 pm

Cece wrote:
CureOrBust wrote:
drsclafani wrote:i gave a talk on early restenosis and "non-responders" and how to address the many causes of these.
oooo.. i'd be very interested in this video.

With nonresponders in quotations, I think this is probably not about true nonresponders who had the procedure done to perfection but didn't result in any change in their symptoms. Instead it would be patients who seem to be nonresponders but whose procedure wasn't thorough enough or the balloons not appropriately sized and so there is hope for a more optimized procedure to turn them into responders.


Dr S I think you could possibly interest BNAC with a video and training, they seem to struggle with the issue of undertreating and then blame! ;)

;)
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Re: DrSclafani answers some questions

Postby munchkin » Mon Apr 22, 2013 1:43 pm

Hi Dr. S

Is it possible for veins to diminish in size due to low/slow flow? If this does happen will altering the flow result in a return to the normal size?

Thanks for your help.
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Re: DrSclafani answers some questions

Postby drsclafani » Wed Apr 24, 2013 7:44 am

drsclafani wrote:
Nigel, I've come to the conclusion that Dr. Arata needs the ever elusive superIVUS that has been discussed here before. (A new improved IVUS intravascular ultrasound that is 10 time sharper than old IVUS.) He is ballooning the area of the valves, as are all the IRs, although he is ballooning valves that appear normal, which is different than all IRs. Normal healthy valve leaflets are too thin to show up on regular IVUS. With the new better IVUS, we could get a moving image of these supposedly normal valve leaflets. Either they are indeed normal or they are thickened as is seen in MS or they might be dysregulated so that the flapping is not in sync. This dysregulation of valve leaflet motion could be a result of the dysautonomia and could contribute to flow disruption, which could explain the improvement Dr. Arata has seen when these valves are ballooned. It is at least a way to investigate but the new IVUS is needed.

OK Dr. Sclafani can have his thread back now. Sorry for too many posts!
[/quote]

this is a mis-attribution to me. or hafve i misread the quote? I believe it is from cece.
i do not think that the "superIVUS" will be available for some time. We must patiently wait for its review and approval by FDA as a new device. We do not know yet what exactly it will improve on or whether it will be 10x more resolution or 100x, of 2x better.
If it is better resolution, it may indeed reveal subtler changes that reflect valvular abnormalities.

However I do not think that valves are regulated as such. They are relatively passive responders to direction of flow rather than being regulated by the autonomic nervous system. if someone has seen data to the opposite, please share.

DrS
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