This Is MS Multiple Sclerosis Community: Knowledge & Support

http://www.cxvascular.com/in-features/i ... -still-out

Have we discussed this before? There's plenty in the article, summing up what was discussed at the Veith Symposium, but the 2% occlusion rate caught my eye. Dr. Mehta had 1 out of ever 50 patients treated result in an occluded jugular. This would have been for procedures performed in late 2010, and most IRs have continued to refine the procedure in the year since then. I guess 2% is really low but the consequences of an occluded jugular seem to me to be very high (considering that I place a high importance on having functioning jugulars). I would like to see 0% occlusions.

Hi Cece

The occlusion rate seems low. Although I do believe we are getting better at understanding how to prevent occlusions.

The restenosis rate is also very low. The basic problem is we do not have a scientifically validated method to even determine what is or isn't restenosis (at least on conventional US). We don't even have a consensus on what constitutes a jugular or azygous vein stenosis.

So your estimate would be higher than 2% for occlusions. I don't like the idea of a good enough procedure if a more perfected procedure is possible.

Here for example is Dr. Sclafani's SIR abstract reporting a reduction of vein injury when IVUS is used in CCSVI angioplasty:
http://www.ccsvicare.org/outreach_update03.html

Let's see...Dr. Mehta is reporting 8% restenosis in his patients at 4 months in the trial. One theory is that Dr. Mehta is very good at what he does, another is that he is not counting all restenoses as restenoses, another is that the restenoses would show up at some later time than 4 months. Dr. Zamboni reported 50% restenosis at 18 months in his 2008 research.

Did you catch a talk from Dr. Zamboni on plethysmography at ISET? That might end up being a method to determine restenosis both in research and clinically. Intra- and inter-operator reliability and reproducibility would be very good things.

We don't have a validated method to determine restenosis, we don't have agreement on what constitutes a jugular or azygous stenosis...it is 2012, I have been following CCSVI since 2009, and it would seem we are still at the beginning of things.

But it is good to see you here again! I had thought the mood at ISET on IVUS was better than what you describe. It is disappointing to hear otherwise.