I think the IR's thoughts are completely reasonable and are echoed by numerous other IR's which is why they aren't rushing to the front of the line to help out.
I think IR's have been taught and assumed that collaterals are sufficient for venous drainage when a main vein is blocked. Because there has not been any direct cause/effect noted, they have assumed that the collateral system was adequate. Many seem to think that your face has to be red and swollen if major vein blockages are significant. If not, you must be fine.
I think what CCSVI questions is whether symptoms take years to develop. This is a new hypothesis that has not been tested. Whether it can be replicated quickly in an animal model outside of waiting 20 years to see if symptoms develop, I don't know. We may be left with treating us and seeing if we have objective measures of the alleviation of symptoms to then be able to attribute those symptoms to the venous blockages. That's what I am hearing the treating IR's saying, they are seeing patterns of symptom alleviation. That's why they are no longer talking about PTA helping MS, they are appreciating that the symptoms that get better are due to vein blockages and PTA improves them, it has nothing to do with MS. MS may be comorbid to CCSVI or not, but we can take CCSVI and treat it and alleviate its own symptoms without any contemplation of MS... it's just that some symptoms that were earlier attributed to MS may actually be a result of venous abnormalities.
So I think this IR makes every valid point that many other doctors are also making. The concerns about stenting is clearly valid too. I think it is either in practicing PTA on the vein blockages and physically seeing the results or having results from blinded trials that will give most doctors what they need to want to get involved. The questions and concerns are good ones.
I understand why many doctors don't want to go out on a limb. It makes us admire those that have all the more. As Dr. Sclafani and others have said, these are NOT typical vein malformations, we're in a whole new ballgame now, they are learning as they go and are making up the treatment as they go along. Some doctors don't want to play until they can observe from the sidelines for a little while longer. I get it. Doctors already went to school for a long time and some just don't want to learn something new, not when they are comfortable with their practice, the degree of risk involved and their existing skill level. Not in this litigous society. Many don't want to be heroes. They just want to earn a decent living helping people out within their existing skill set.