CCSVI and the doubtful promise of an endovascular treatment

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

Postby malden » Thu Oct 28, 2010 2:37 pm

cheerleader wrote:Normal internal jugular pressure is measured in cm of H2O. Normal internal jugular venous pressure is 5-9 cm H20. It can be as low as 2 cm H2O and still "normal."
http://www.turner-white.com/pdf/hp_may02_veins.pdf
As you can see from Dr. Zamboni's study, the pressure pre-angioplasty is the IJVs he treated was up around 14. That is NOT normal. It is too high.


Dr. Zamboni uses the exact same venous measurements that are taken in Budd Chiari disease, a disease of venous congestion of the liver due to hepatic vein occlusion...this is how venous pressure is measured pre and post angioplasty---in cm of H2O

All three hepatic veins were reopened in 23 patients (Table 2). The average pressure in the IVC was 25.1 cm H2O preoperatively and 11.8 cm H2O at the time of discharge.

http://ats.ctsnetjournals.org/cgi/conte ... 711#TABLE2

What Dr. Zamboni found was a significant change in internal jugular and azygos vein pressure after angioplasty. THis cannot be denied. This is the way venous pressure is measured. period.
cheer


But in the same time we don't know what was the presure in carotid artery? Was it normal to?

As you can see from diagram on previous page, from Dr. Zamboni's study, the pressure post-angioplasty in the IJVs he treated was up around 12.5 (in cm of H2O). By in Your/Zamboni standards, that is NOT normal. It is too high too ....You/Zamboni said normal is 5-9 (in cm of H2O). Still abnormal, angioplasty can't fix it.... is this pocedure useless??
Last edited by malden on Sat Oct 30, 2010 1:23 am, edited 2 times in total.
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Postby MrSuccess » Thu Oct 28, 2010 4:07 pm

once again ..... '' it won't work '' ..... is hardly scientific evidence

thankfully ...... those willing and able to offer more than verbal nonsense ..... appear to be meeting with some moderate success'.

On a very sad note ..... the procedure has not given the results desired -YET- for everyone . But tomorrow is another day.

The medical community is advancing ..... in spite of the critics .

I have not read one single medical paper or Trial result ..... that has me doubting CCSVI .... the diagnosis .... the treatment ..... or the incredible medical professionals supporting it .

As it is baseball season ..... and I like sports analogy's [ sp ... Pam :wink: ] .... CCSVI is like baseball ..... 10 batters come to the plate ..... the best ones hit the ball 3 out of 10 attempts .... some more ... some less ...... the so-called skeptics rejoice in all those fail - to - hit attempts . They say .... I told you it won't work [ hitting the ball ]

And they are right 70 -80 % of the time .

Right now CCSVI is batting low average ....... just give our batting coach's [ Zamboni , Dake , Haacke , Sclafani ... Hubbard ] more time to work with the team ..... [ Hey ... it's a new franchise :wink: ] and our averages will climb ....

you read here first :idea:




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Postby AMcG » Thu Oct 28, 2010 5:57 pm

“Pretreatment pressures beyond the stenosis were not significantly different than normal venous pressure and there was no significant change in pressure after angioplasty. “

What bothers me about this quote is not that it has implications for CCSVI treatment if it were true but what it demonstrates about the accuracy of this report. The quote is part of a resume of Zamboni’s paper in 2009 and states that Zamboni measured no significant difference. In fact Zamboni reported the difference was significant with graphs, p values and the name of the test he used.

The authors of the piece of course have the right to disagree with Zamboni but if they summarise or quote from his work they must do so accurately. Failure to do that is unforgiveable in a piece which purports to be considered and authoritative. Since there are other factual errors in the report I cannot help but think this is merely a cynical attempt to enhance their CVs with another publication while contributing nothing new to the debate.

I think it is significant that papers like this one seem to get published very quickly (i.e. as soon as they are submitted) and they always contain obvious errors and very dodgy logic. They are not going to impress any serious researcher who actually knows the relevant literature.
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Postby drsclafani » Thu Oct 28, 2010 8:41 pm

Malden wrote:
squiffy2 wrote:...
Finally, in 2009, Zamboni et al reported their results on the endovascular treatment of 65 MS patients with CCSVI.
No isolated venous lesion was found, and the distribution of venographic patterns was 30%, 38%, 14% and 18% of types A to D, respectively.
They performed percutaneous transluminal angioplasty (PTA) on all but one azygos lesion that did not respond to PTA alone and required stent placement.
Pretreatment pressures beyond the stenosis were not significantly different than normal venous pressure and there was no significant change in pressure after angioplasty.
...


That's the key where Zamboni's theory can not keep wather:

No change in presure gradients results in no change in flow. Same blood flow before and after PTA?! Why are we doing PTA if flow is the same (not Liberated)?


pressure is not the same as flow

pressure does not come down, because pressure was low before treatment.;
however it is clear that flow is greater after angioplasty, all one has to do is see that the dye trickles out of the vein before treatment, and flushes out strongly after.

so if flow down the jugular vein is improved, it means that it does not have to flow through the small veins to find a way out.
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