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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