This Is MS Multiple Sclerosis Community: Knowledge & Support

[Cece]

Dr. Ferral's abstract is on page 83 of the ISNVD abstracts. http://www.isnvd.org/files/ISNVD%20Abstract%20Book.pdf
Endovascular management of CCSVI: Single Center Experience
Dr. Ferral has IRB approval and did a retrospective analysis of 95 patients. He is indeed using IVUS. Dr. Ferral is in Chicago.

[itsjustme]

5 patients lost to follow-up?

he told me to contact a neurogist about a dmd!

[Cece]

Was this in addition to checking for restenosis of the veins, or instead of checking? I think seeing a neurologist and considering a DMD or, if in acute relapse, steroids is a response to MS lesions, but only one part of the total response.

I want to like Dr. Ferral. He is here in the Midwest, as I am. We're doing pretty well for ourselves out here, if we've got two of the very few IRs who are using IVUS clinically. I have heard from his patients that he is conservative in treatment. His numbers seem to reflect conservative treatment as well: only 2.6% of lesions required a stent; only 55.5% of patients reported a positive response lasting over four weeks in at least one of their symptoms; 35.5% of patients reported no improvement. (Which is right on with our original 2010 rule of thumb from Dr. Siskin that a third of patients had no improvements. If EHCs study had required the improvement to last over four weeks, that might have affected the percentages, which were that 91% of patients had immediate improvement.)

Major complications in 3% included thrombosis. He does not say how thrombosis was treated or if it resolved. Final comments call for multidisciplinary prospective trials to further understand and validate the concept of CCSVI.

[itsjustme]

this was when the original thrombus remained after 6 months of drug treatment

[Cece]

How are you now? There are other doctors who do RF laser ablations on thrombosed veins but I don't know with what success. RF laser may be more feasible if it is a clotted stent and not a plain clotted jugular. Dr. Driscoll had an abstract looking into Diamox (Acetazolamide) which increases brain perfusion and may be a useful drug for patients who still have reduced perfusion after a procedure or because of lost jugulars. We've just heard bad news about the AZ patient who had his occluded jugular replaced in a bypass procedure but has now clotted.

For what it's worth, if you were counted in this study, you would have been counted in the 3% major complications, not the 5% lost to follow-up. He knew you had thrombosed. The lost to follow-up group would be patients who he never heard from again, and doesn't know what the outcome was

[Cece]

Here's a nice slideshow presenting Dr. Ferral's study and results:
http://www.slideshare.net/cdyte/ccsvi-h ... -enero2012

Under materials & methods, he says the intravascular ultrasound is an 8 French Volcano system, that he advances the catheter to the mid-neck level, that he does a slow withdrawal looking for stenotic areas or tight valves, and that vein measurements are obtained.

Indications for angioplasty are:
severe stenosis or reflux seen on venogram
severe stenosis seen on IVUS
thick rigid valve seen on IVUS

It's interesting to note that if IVUS were not used, two out of those three indications for angioplasty would be gone.

It's also of interest that he only advances the catheter to the mid-neck level. I wonder why he does not advance it to the top of the jugular?