DrSclafani answers some questions

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

Re: DrSclafani answers some questions

Postby Cece » Sat Jun 21, 2014 3:26 pm

drsclafani wrote:sorry for the delay. Again, i received no notifications that there were questions here. I do not know what i did to cause that.

If you go to the top of the page, under "DrSclafani answers some questions" and under "new topic" and "post reply," there is "Subscribe topic." Clicking it should get you subscribed again.

If that doesn't solve it, then check that you are still using the same email that notifications are being sent to and check to see if notifications are getting routed automatically to the trash or spam folders.

Alas, with no notification, how will you see this message telling you how to get notifications?
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Advertisement

Re: DrSclafani answers some questions

Postby pelopidas » Sun Jun 22, 2014 7:13 am

drsclafani wrote:
erinc14 wrote:I've had stents over 3 years and sometimes when I yawn or move my head I get a sharp pain on the left side of my neck . not always though . is this normal ?

eric, what is normal? certainly not a stent. it would guess that you have a stent up high in the neck, possibly due to a compression stenosis in J3. Am i correct?

DrS

i recently met an MSer with such stents in both jugulars in his first procedure
could you please explain the pros (if any) and cons?
what can a patient do after such stents are already put in the jugulars?
Last edited by pelopidas on Thu Jun 26, 2014 1:46 pm, edited 1 time in total.
getafix
pelopidas
Family Member
 
Posts: 67
Joined: Mon Sep 05, 2011 7:30 am
Location: Greece

Re: DrSclafani answers some questions

Postby dlynn » Thu Jun 26, 2014 6:03 am

Dr. Sclafani,
Is it safe to assume, since you placed stents and I have no more pain, that blood flow is normal and my LRV is patent and without clot?
And also, if blood flow is normal through those stents, is that any indication that stents if placed in, say, IJVs or Azy
would fare as well?

Thank you
Last edited by dlynn on Thu Aug 14, 2014 3:20 pm, edited 1 time in total.
User avatar
dlynn
Family Elder
 
Posts: 203
Joined: Thu Jul 28, 2011 3:00 pm

Re: DrSclafani answers some questions

Postby Cece » Thu Jun 26, 2014 9:48 am

dlynn wrote:Would you ever consider stenting any of these (IJ, Azy) veins if a patient had four failed CCSVI procedures?



drsclafani in Feb 2012 wrote:I have described five indications for stenting:
1. injury to the vein during angioplasty, such as dissections that put the vein at risk of early occlusion and thrombosis or perforations that increase risk of hemorrhage.
2. multiple recurrent stenoses over a short period of time
3. stenoses that refuse to dilate by angiolasty alone
4. after recanalization of occlusions that occured previously
5. Compression syndromes that do not respond to angioplasty, such as May thurner syndrome and Nutcracker syndrome.


That might fall under #2? I don't know how long "over a short period of time" would be. I know it's important to be wary and not count underdilatations or incomplete procedures as failed procedures.
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Re: DrSclafani answers some questions

Postby drsclafani » Fri Jul 04, 2014 8:54 am

drsclafani wrote:
erinc14 wrote:I've had stents over 3 years and sometimes when I yawn or move my head I get a sharp pain on the left side of my neck . not always though . is this normal ?

eric, what is normal? certainly not a stent. it would guess that you have a stent up high in the neck, possibly due to a compression stenosis in J3. Am i correct?

DrS

eric, care to reply?
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com
User avatar
drsclafani
Family Elder
 
Posts: 3142
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Re: DrSclafani answers some questions

Postby drsclafani » Fri Jul 04, 2014 11:43 am

Cece wrote:
drsclafani wrote:sorry for the delay. Again, i received no notifications that there were questions here. I do not know what i did to cause that.

If you go to the top of the page, under "DrSclafani answers some questions" and under "new topic" and "post reply," there is "Subscribe topic." Clicking it should get you subscribed again.

If that doesn't solve it, then check that you are still using the same email that notifications are being sent to and check to see if notifications are getting routed automatically to the trash or spam folders.

Alas, with no notification, how will you see this message telling you how to get notifications?


thanks cece
i think i found that the notification was indeed in my spam folder: hopefully corrected.
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com
User avatar
drsclafani
Family Elder
 
Posts: 3142
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Re: DrSclafani answers some questions

Postby drsclafani » Fri Jul 04, 2014 12:09 pm

pelopidas wrote:
drsclafani wrote:
erinc14 wrote:I've had stents over 3 years and sometimes when I yawn or move my head I get a sharp pain on the left side of my neck . not always though . is this normal ?

eric, what is normal? certainly not a stent. it would guess that you have a stent up high in the neck, possibly due to a compression stenosis in J3. Am i correct?

DrS

i recently met an MSer with such stents in both jugulars in his first procedure
could you please explain the pros (if any) and cons?
what can a patient do after such stents are already put in the jugulars?

Again, sorry for the delay in answering.

1. stents have value in creating an expansion of a stenosis that would be resistant to expansion, have a propensity to elastic recoil back into a stented shape or are compressed by extrinsic surrounding tissue and structure. They are helpful in salvaging thromboses and vein wall tears or dissections caused by angioplasty.
2. Stents have several downsides, some of which include:
They add cost to the procedure
They may be deployed improperly
they may migrate out of the target blood vessel
They can thrombose
They can develop intimal hyperplasia that can result in stenosis within the stent.

3. The first thing that a patient with stents should do is make sure that they have a clear record of:
the type of stent (self expanding, balloon expanded)
the manufacturer
the name, model, and manufacturer serial number, plus,ideally, a barcode of that stent
The chemical composition of the stent and whether the stent is MRI compatible
The vein in which the stent in deployed and its location within that vein
The type of anticoagulation prescribed and taken, the dose and duration of anticoagulation

4. They should consult the deploying physician regarding a surveillance follow-up program. I think Ultrasound is as good as we have for the initial surveillance which looks for stent patency, thrombosis, fracture or migration and stenosis, either due to external kinking or compression of the stent or intraluminal in-stent stenosis secondary to intimal hyperplasia.

5. I cannot make a general recommendation about anticoagulation: some recommend life long anticoagulation, others short term anticoagulation. I like my patients to remain on anticoagulation until ultrasound shows a reasonably long period with absence of intimal hyperplasia or regression of intimal hyperplasia. An antiplatelet agent such as low dose aspirin is also helpful.


Generally, once stents are placed and develop reasonable endothelial coverage, it becomes unreasonable to consider extraction unless the patient quality of life is severly compromised. Some balloon expandable stents can be externally compressed by extrinsic pressure on the neck or by neck movements such as lateral rotation. These deformities may not spontaneously reform their intended shape and can kink the stent. This should be discussed with your doctor.
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com
User avatar
drsclafani
Family Elder
 
Posts: 3142
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Re: DrSclafani answers some questions

Postby dlynn » Sat Jul 05, 2014 12:06 pm

Dr. Sclafani,
Is it safe to assume, since you placed stents and I have no more pain, that blood flow is normal and my LRV is patent
and without clot?
And also, if blood flow is normal through those stents, is that any indication that stents if placed in, say, IJVs or Azy
would fare as well?
In what situation would you use a self expanding balloon?

Thank you
Last edited by dlynn on Thu Aug 14, 2014 3:27 pm, edited 1 time in total.
User avatar
dlynn
Family Elder
 
Posts: 203
Joined: Thu Jul 28, 2011 3:00 pm

Re: DrSclafani answers some questions

Postby pelopidas » Wed Jul 09, 2014 9:56 pm

dlynn wrote:Dr. Sclafani,

Thank you
p.s. here you are at 46-47 minute mark http://video.pbs.org/video/2365271212/

this link is not available due to "right restrictions"
is there any other link available?
getafix
pelopidas
Family Member
 
Posts: 67
Joined: Mon Sep 05, 2011 7:30 am
Location: Greece

Re: DrSclafani answers some questions

Postby NHE » Thu Jul 10, 2014 11:21 pm

pelopidas wrote:
dlynn wrote:Dr. Sclafani,

Thank you
p.s. here you are at 46-47 minute mark http://video.pbs.org/video/2365271212/

this link is not available due to "right restrictions"
is there any other link available?


It's part of the movie "When I Walk" by Jason DaSilva.

http://www.pbs.org/pov/wheniwalk/
User avatar
NHE
Volunteer Moderator
 
Posts: 3355
Joined: Sat Nov 20, 2004 4:00 pm

Re: DrSclafani answers some questions

Postby Robnl » Wed Jul 30, 2014 10:30 am

Hi doc,

I've read that there is still no progress on the hubbard registry, why?

Rgds,

Robert
User avatar
Robnl
Family Elder
 
Posts: 429
Joined: Sun Nov 08, 2009 4:00 pm

Re: DrSclafani answers some questions

Postby pelopidas » Fri Aug 01, 2014 4:48 am

getafix
pelopidas
Family Member
 
Posts: 67
Joined: Mon Sep 05, 2011 7:30 am
Location: Greece

Re: DrSclafani answers some questions

Postby Robnl » Mon Sep 01, 2014 9:22 am

Hi doc,

Everything ok? Last post on july 4th....
User avatar
Robnl
Family Elder
 
Posts: 429
Joined: Sun Nov 08, 2009 4:00 pm

Re: DrSclafani answers some questions

Postby dlynn » Mon Sep 08, 2014 5:50 am

Hi Dr. Sclafani,
Hope you are well. It's quiet around here, please stop in and visit us
User avatar
dlynn
Family Elder
 
Posts: 203
Joined: Thu Jul 28, 2011 3:00 pm

Re: DrSclafani answers some questions

Postby Cece » Sun Sep 14, 2014 5:37 pm

I hadn't realized it had been that long!!
I found an image of jugulars that has me uncertain.
It's from a chapter on CCSVI by Dr. Siskin & Dr. Vachon in Endovascular Interventions. http://link.springer.com/chapter/10.100 ... -7312-1_78

Image

The Fig. 78.1 caption says that these images demonstrate normal anatomy of the mid- and distal portions of the vein. But in b, I think I see a narrowed portion in the mid-vein where the contrast looks lighter with one small collateral vein around it.
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

PreviousNext

Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service