HappyPoet wrote:Cece, I thought the following is the approximate timeline for restenosis -- comments? Thx!
1st: Recoil, from immediately to several weeks after venoplasty.
2nd: Thrombosis (clotting), from immediately (rare) to several months after venoplasty.
3rd: Intimal hyperplasia, from several weeks to one year after venoplasty.
I know strong anticoagulants can help control thrombosis, but, with the exception of complete luck, do you know any way that intimal hyperplasia can be avoided? Thx!
You know as much as I do, HappyPoet. If restenosis happens within the first few weeks, elastic recoil is a big suspect or else clotting. I think the timeline on the clotting is that immediate is quite possible, within the first few weeks is quite possible, and it's possible but less common after a few months. It would seem to depend on flow too; clotting is less likely if you have good flow and more likely if you have bad flow. We don't know for sure if strong anticoagulants are necessary, but I am for them.
Intimal hyperplasia is more of a long-term thing but not as known if it occurs in CCSVI veins, it's well understood in arteries. But one year is always listed as the end point for intimal hyperplasia, that's why if we're talking needing a venoplasty three years later, I don't think it's intimal hyperplasia.
I think healthy lifestyle and Joan's endothelial health program on ccsvi.org and specifically fish or fish oil supplements or cod liver oil, because those have been tested in mongrel dogs and were able to reduce the incidence of intimal hyperplasia, specifically when taken the week before the procedure and the week after. These are however blood thinners and would need to be cleared with a doctor. Plavix and aspirin are antiplatelets and a component of intimal hyperplasia is when the platelets adhere to the site of injury where the ballooning happened, then the platelets drop the platelet-derived growth hormone on the vein, and the smooth muscle cells are activated by this and begin growing. If you don't have platelet cells adhering, you might avoid some of that cycle, that is why antiplatelets like plavix and aspirin and cod liver oil are potentially of use. I've considered clotting a much bigger risk because of all the clotting outcomes we've heard of, when jugulars are no longer accessible and may shrivel up and die, which is a horrible thought. Another possible factor in intimal hyperplasia is if doctors are ballooning too large or at too high of pressures (what is too large? what is too small? too high, too low of pressure? We just don't know yet.). And another possible factor is if doctors are ballooning areas that don't need to be ballooned, instead of finding and focusing on the specific area of stenosis; that's where IVUS comes in, when it comes to finding where to balloon and where not to balloon.
It will be a joy to see the research come in over the next few years and maybe there will be a little more to go on when trying to figure this all out.