drsclafani wrote:We have allowed a suboptimal screening test to take center stage while obvious venographic abnormalities are amply and routinely seen in the peer reviewed literature. These venographic findings, reported in an adequate number of studies, have been largely ignored. The limitations of venography, inherent in a luminal imaging study of an intraluminal disease, only emphasize the degree of significance of these abnormalities. When augmented by an endoluminal imaging study such as intravascular ultrasound, the prevalence of venous abnormalities in patients with MS cannot be rejected.
I have seen image after image of abnormal jugular. They are recognizable. If all IRs had seen as many CCSVI jugular venograms as I have seen, we might be further along. Not to give up on the neurologists, but I expect great things from the IRs because they are the ones who understand blood flow and who can look at the same images as we have looked at and see the same things.
But proving this association is only of secondary importance. What is most important is that some patients with venous outflow obstructions have symptoms that improve after angioplasty, and at a higher rate than that described for placebos in trials of medications and other therapies. This is the most important thing that we have learned in three years.
I'm guessing this is important because symptom relief is reason enough to proceed with the intervention, and figuring out all the rest such as cause and impact of ccsvi treatment on future disease course can happen at the slower pace?