Dr. Sclafani's Italy Presentation

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

Postby Cece » Wed Jul 07, 2010 12:58 pm

Thanks, Nunzio, great link too...I see exactly what you're saying about the backbone.

You say a stent would still be good in the above case, do you disagree with the reasons DrS gave for why he would not stent there?
1. stenting a physiological narrowing may be a problem when that narrowing distends by treatment of lower more likely stenoses. it is possible that the stent will no longer be pressed against the wall of the vein and thus migrate toward the heart.
2. stents have the risks of in-stent stenosis leading to loss of the vein completely...certainly do not want to put one there for a physiological distensible narrowing
3. putting pressure on the wall of the carotid at the carotid bulb by stenting the vein may result in physiological responses including a slow heart rate
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Postby Nunzio » Wed Jul 07, 2010 2:36 pm

Cece wrote:Thanks, Nunzio, great link too...I see exactly what you're saying about the backbone.

You say a stent would still be good in the above case, do you disagree with the reasons DrS gave for why he would not stent there?
1. stenting a physiological narrowing may be a problem when that narrowing distends by treatment of lower more likely stenoses. it is possible that the stent will no longer be pressed against the wall of the vein and thus migrate toward the heart.
2. stents have the risks of in-stent stenosis leading to loss of the vein completely...certainly do not want to put one there for a physiological distensible narrowing
3. putting pressure on the wall of the carotid at the carotid bulb by stenting the vein may result in physiological responses including a slow heart rate

Partially: the way I would proceed is this, related to # 1.
I would balloon the lower stenosis.
Recheck upper narrowing; if gone do nothing.
If still present since narrowing=decreased flow I would ask the patient to go in valsalva and measure the diameter of the vein and then use a slightly larger stent. Alternatively a compliant balloon (soft,low pressure) could be used just to assess the vein diameter. This should prevent stent migration.
Point #2 and #3 I would defer to Dr.Ludyga and Simka.
They have done hundreds of these procedures without apparently any major problem.
Cece, maybe we can open a liberation treatment center together; I am not an I.R. or Vascular surgeon, but I have an Italian name.
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Postby Cece » Wed Jul 07, 2010 2:41 pm

Nunzio wrote:Cece, maybe we can open a liberation treatment center together; I am not an I.R. or Vascular surgeon, but I have an Italian name.

I'm in. I have a baggie full of balloons and pretty sure I can pick up any stents or that sort of thing at the hardware store. :)

We just need some guy named Irb to watch over us and we're set.
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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