NHE wrote: miri wrote:
OK, I finally checked them out, and I vote most for Rogan's video's since they quickly explain to novices what it's all about. Granted the others are amazing before-and-after's... but I was seeking more in the line of a quick education.
Hey, even Rogan's could have been condensed by a professional into one shorter video showing the "meat" of the matter. To give an unrelated example, I think the below parchment-cone video is better than the more-popular parchment-cone video's, since it offers "instant yet concise education" - see what i mean?http://www.youtube.com/watch?v=i-rb4BR_dgI
I doubt that you're ever going to find a step-by-step "do it yourself at home" CCSVI video. Instead, read some of Dr. Sclafani's several case study posts. These are a invaluable resource for people wishing to learn about CCSVI.
Thanks for the compliment. It deserves a response and here is an interesting case from this past week.
A 35 year old Canadian man with a rather aggressive form of RRMS resulting in cognitive dysfuction, memory difficulties, weakness and spasticity, fatigue, terrible imbalance, heat intolerance, depression.
He was seen by me in March 2013 where ultrasound revealed hemodynamic abnormalities on doppler that were consistent with CCSVI and thickened elongated immobile valves by Bmode ultrasound.
He underwent venography.
RIGHT INTERNAL JUGULAR VENOGRAPHY
Right sided venography (shown) and IVUS demonstrated about 95% internal jugular valvular stenosis, and compression stenosis of the mid-jugular vein. The valve stenosis was treated with a 20 mm high pressure balloon. The final image after several angioplasties looked pretty good to me.
LEFT INTERNAL JUGULAR VENOGRAPHY
Left internal jugular venography revealed a similar valvular stenosis (orange arrows) as well as a stenosis from muscular compression (green circles).
The valvular stenosis was treated with a 16 mm high pressure balloon angioplasty. The compression stenosis was not treated. Endovasccular treatment of external compression would require stenting and I am reluctant to implant a permanent device for a phasic lesion that may not be significant This is certainly a hot topic of the moment but there is little clarity.
The patient had rather immediate, rapid and dramatic improvements in all of his symptoms. We were quite pleased. However after one week symptom improvements regressed rather quickly back to his baseline condition.
My advice was to "stay the course" , see if improvements returned. But they did not. All gains were lost.
The possible explanations are many:
Was this a short lived placebo effect?
Was something missed?
Did he have a relapse?
Did he thrombose a jugular?
Did he have restenose his valves?
Was he a non-responder?
Obviously, the most urgent consideration was thrombosis. Reversal of thrombosis requires rapid response to recanalize the occluded bein before the clot turned into scar tissue. Thankfully, ultrasound did not show any evidence of thromosis. However ultrasound showed abnormal valves and reflux.
We had some difficulty coordinating a return visit but the patient was seen again at two months after procedure. Venography was performed again, with completion of venography of both dural sinuses, jugular veins, brachiocephalic veins, the azygos vein, the left renal vein, the ascending lumbar vein and the inferior vena cava.
LEFT INTERNAL JUGULAR VEIN:
As you can see, the stenosis of the internal jugular valve has recurred.
RIGHT INTERNAL JUGULAR SYSTEM:
Similarly recurrent stenosis of the right valvular aparatus was quite apparent and significant.
Generally, I prefer to give angioplasty a second try as the next manuever. I prefer to withhold stenting after the first restenosis because some patients respond quite nicely to a second angioplasty and stenting can be avoided. The patient was quite concerned about repeated trips to New York City since his brother lived much further from new york and this was an impractical solution. Therefore I agreed to stent if restenosis was found.
I did not want to stent both sides so I thought to stent the most narrowed and larger vein and treat the other vein with simple angioplasty.
Therefore I treated the left side by repeat angioplasty and stented the right internal jugular vein using a Wallstent.
I do not have any good explanation why the effects of this patient's angioplasty proved to be so short lived. Perhaps the valve was incompletely opened the first time. perhaps it was just too thick to stay open. I must reveal that even after placement of the stent, balloon angioplasty had to be performed to get the valves to open completely.
I wait very impatiently to learn whether stenting of recurrent stenosis has been helpful.