if a doc has said you have intimal hyperplasia or regrowth

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

if a doc has said you have intimal hyperplasia or regrowth

Postby Cece » Thu Jan 06, 2011 4:47 pm

If a doc has said you have intimal hyperplasia or regrowth of the vein lining as a healing response, will you mind posting here?

If a doc has said that you have the intimal hyperplasia type of restenosis AND you happen to know what sizes/pressures/durations of ballooning were used, that would be especially helpful. I'm wondering about people who had venoplasty and no stents.

We often hear restenosis mentioned, but not as often what type of restenosis it is. The concern has been raised that intimal hyperplasia could be a risk of the more aggressive ballooning sizes and pressures.

Oh, also, it would also be helpful to know if you were on aspirin or plavix from the time of the procedure, particularly the first week afterwards.

thanks, you guys are the best.
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Postby DrCumming » Fri Jan 07, 2011 4:23 pm

Cece, I am not sure most patients will have the data we need but..

We need to not only know the balloon size, we also need to know the size of the normal segment of jugular vein. And the segment of vein treated. At this time, I think just collecting data of the proximal IJ would be best. The lesions at the skull base are a different animal.

Also would be interested to know at what pressure (atmospheres) the stenosis resolved at.

Balloon inflation time would also be interesting. Cutting balloon or cutting wire technique as well.

Post procedure anticoagulation (lovenox, aspirin, plavix, coumadin etc).

Would like to have the details of the various study protocols to see if that is being collected. Part of the problem at this point is we do not even know everything we should be tracking. Makes it hard to design a good study.
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Postby Cece » Fri Jan 07, 2011 4:50 pm

We could add some of those questions into the tracking thread, they're good ones. (But you are talking about the real studies, not the anecdotal tracking we are doing here.)

xia wrote:... My last scan in July showed in stent thombosis and I have been put on Warfarin. I contacted Dr Simka to let him know what my vascular consultant said and he replied saying that it might not be a clot but something called intimal hyperplasia. This is the stent irritating the vein lining. He said he has seen alot of it. ...


http://www.thisisms.com/ftopicp-140001.html#140001

I've heard reports here of intimal hyperplasia like xia had, but always in conjunction with a stent.
Last edited by Cece on Sun Jan 09, 2011 11:22 am, edited 1 time in total.
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Postby drsclafani » Sun Jan 09, 2011 8:19 am

mjc701 wrote:Cece, I am not sure most patients will have the data we need but..

We need to not only know the balloon size, we also need to know the size of the normal segment of jugular vein. And the segment of vein treated.

I could not agree with you more

At this time, I think just collecting data of the proximal IJ would be best. The lesions at the skull base are a different animal.


True, but they are both interesting animals. I suggest at least three separate data collections. Truncular annular stenosis fo the jugulars, hypoplasia of the jugulars and azygos problems makes three.....curious how azygos lesions have such apparent fewer restenoses...I think that this would be a good start

Also would be interested to know at what pressure (atmospheres) the stenosis resolved at.

Balloon inflation time would also be interesting. Cutting balloon or cutting wire technique as well.

Post procedure anticoagulation (lovenox, aspirin, plavix, coumadin etc).

Would like to have the details of the various study protocols to see if that is being collected. Part of the problem at this point is we do not even know everything we should be tracking. Makes it hard to design a good study.[/quote]

i agree with you.
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Postby Cece » Sun Jan 09, 2011 9:41 am

drsclafani wrote:
mjc701 wrote:At this time, I think just collecting data of the proximal IJ would be best. The lesions at the skull base are a different animal.


True, but they are both interesting animals. I suggest at least three separate data collections. Truncular annular stenosis fo the jugulars, hypoplasia of the jugulars and azygos problems makes three.....curious how azygos lesions have such apparent fewer restenoses...I think that this would be a good start

When Dr. Cumming says "lesions at the skull base" and Dr. Sclafani says "hypoplasia of the jugulars," is that the same animal these days? (So that the lesions at the skull base are most commonly either physiological narrowings or hypoplastic jugulars?)

(Last spring, magoo raised the question, during a discussion of physiological narrowings, then why did getting just upper jugular stents cause her collaterals to collapse and result in so much improvement? Hypoplasia was not on the radar as much back then but now that it is, perhaps that could be why.)

Dr. Cumming, with the Hubbard registry, is it already set what data you would collect if you participate in the Hubbard registry or is that up to you?
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Postby drsclafani » Tue Jan 11, 2011 9:47 pm

Cece wrote:
drsclafani wrote:
mjc701 wrote:At this time, I think just collecting data of the proximal IJ would be best. The lesions at the skull base are a different animal.


True, but they are both interesting animals. I suggest at least three separate data collections. Truncular annular stenosis fo the jugulars, hypoplasia of the jugulars and azygos problems makes three.....curious how azygos lesions have such apparent fewer restenoses...I think that this would be a good start

When Dr. Cumming says "lesions at the skull base" and Dr. Sclafani says "hypoplasia of the jugulars," is that the same animal these days? (So that the lesions at the skull base are most commonly either physiological narrowings or hypoplastic jugulars?)

(Last spring, magoo raised the question, during a discussion of physiological narrowings, then why did getting just upper jugular stents cause her collaterals to collapse and result in so much improvement? Hypoplasia was not on the radar as much back then but now that it is, perhaps that could be why.)

Dr. Cumming, with the Hubbard registry, is it already set what data you would collect if you participate in the Hubbard registry or is that up to you?


cece
as we have discussed. there are ways to differentiate high lesions or hypoplastic lesions of the upper jugular vein from size reduction due to inadequate blood flow through the vein.

Blood flow reduction leading to collapse of the vein is often seen in several specific locations of impingement, namely,
1. at the level of the second cervical vertebra's transverse process
2. where the carotid bulb impinges upon the jugular vein
3. where the neck strap muscles can impinge upon the carotid.

#1 and #3 are often symmetrical. They often distend when the lower stenoses are resolved and flow improves. One can also assess them with IVUS. By activating the thoracic pump one may increase flow and IVUS often shows dynamic distension and collapse in this circumstance.

#2 is also well seen by IVUS where one actually sees the carotid artery impinging.

Further if one balloons these areas, one notices that the balloon distends without any real increase in balloon pressure.

Dr Zamboni was quite adamant that the upper lesions were not the problem. If one believes in the malformation model, then most of the circumferential stenoses are located at the sites of formation of branch points and openings where valves are located such as the jugular and azygos confluens.

As you know, I am a great admirer of Dr Zamboni and rely greatly on his knowledge, wisdom and experience. However i have come to see that SOME of the upper narrowings are real: they are not ALL due to hypovolemia in the vessel as he has asserted

Dr cummings, would you be interested in joining me in another thread, entitled DrSclafani dialogues and debates wiith other physicians ?

s
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