Dr. Mandato at ISNVD

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

Dr. Mandato at ISNVD

Postby Cece » Tue Feb 21, 2012 1:21 pm

http://www.isnvd.org/files/ISNVD%20Abstract%20Book.pdf
on page 62
Short-Term Outcomes After Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency (CCSVI) in Patients with Multiple Sclerosis
A retrospective study of 213 patients treated for CCSVI.
A mean of 2.2 veins treated per procedure.
CONCLUSIONS:
Endovascular treatment of CCSVI can produce
significant, short-term improvement in physical and mental healthrelated
QOL. However, improvement occurred less often in patients
with SPMS than in patients with RRMS and PPMS. In addition, while
the years since MS diagnosis did not appear to be related to QOL
improvement after angioplasty, the frequency of improvement was
less in patients with >10 yrs since MS diagnosis when compared
with patients diagnosed within 10 years of the procedure. While this
retrospective data is encouraging, a prospective randomized trial
is needed to rigorously evaluate the role of endovascular CCSVI
treatment in MS and to understand the implications of the present
study in terms of patient selection.
Now we're starting to look at who are responders and who are not. I don't think patient selection should be limited to RRMS and PPMS just because improvement occurred less often in SPMS. Physical health improvement was seen in 59% of patients with SPMS. Mental health improvement was seen in 50% of patients with SPMS. Those are still high percentages, even if the RRMSers were higher.
Cece
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Re: Dr. Mandato at ISNVD

Postby Cece » Wed Feb 22, 2012 5:55 pm

from Arlene Hubbard's report of the final day of ISNVD:
https://www.facebook.com/pages/Hubbard- ... 9665829860
Kenneth Mandato
Quality of life changes after endovascular treatment for CCSVI in pts with MS
Treated 2,000 treated
Eval short term outcomes
Retrospecrive study during 4 months
Pre an post ms quality of life
213 txd 90% response rate
rrms 96
spms66 pts
ppms 30pts
189 angioplasty alone
3 pts ango with stent
192…physical health socre improved 9 points
mental health score improved 8 points
significant improvement mostly in the rrms 77%
ppms 77% 59% with spms
venoplasty can significantly improve symptoms short term
They have treated 2,000 patients! He's got the numbers.
Some of this is a repeat of what's in the abstract, and may be more easily understood by reading the abstract.
Patients with SP MS might want to have lower expectations going into this procedure. I would have expected that it was patients with PP who were less likely to respond, but that's not what this data is suggesting. Patients with SP MS might be further into their disease with more accumulated MS damage. But I still don't want to hear that talk about patient selection. 59% of patients with SPMS improved, and if there's no way to know who will improve or who won't, or who will have their further progressions slowed because of improved flow, then it is best not to limit who receives the procedure.
Cece
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Re: Dr. Mandato at ISNVD

Postby Cece » Sat Feb 25, 2012 5:59 pm

page 63 http://www.isnvd.org/files/ISNVD%20Abstract%20Book.pdf

The Role of Doppler Ultrasound in the Diagnosis of Chronic Cerebrospinal Venous Insufficiency (CCSVI) in patients with Multiple Sclerosis
Conclusions
The present study demonstrates that the findings on a
Zamboni-protocol US are not associated with findings on
contrast venography. Therefore, ultrasound cannot be
considered a suitable test for the diagnosis of CCSVI in MS
patients. While other have reported on the inability of US to
consistently detect MS, we do not feel that this calls the
entire theory of CCSVI into question. It has simply led us to
conclude that as a non-invasive screening test that correlates
poorly with a more definitive venogram, ultrasound cannot
be used to definitively determine if someone has treatable
jugular or azygos vein disease in the setting of CCSVI.
This is
likely due to the fact that patients were treated with
angioplasty if they had either a ≥50% stenosis or a <50%
stenosis in association with a significant flow abnormality in
at least one vein. Because our rate of treatment was so high
(97%), we uncovered a false negative rate of 99% for
ultrasound. In light of these findings, we are no longer
requiring a pre-procedure ultrasound examination for
screening prior to venography because it neither guided
treatment nor determined if treatment was needed in a
significant number of patients in this study. A prospective
study is needed to define the role of US and other modalities
in the non-invasive diagnosis of CCSVI.
A false negative rate of 99% is incredibly high. We have seen people post here who say they were tested for CCSVI and didn't meet the criteria. This is encouraging that, even if ultrasound is negative for CCSVI, a patient can go ahead and have a procedure and is 99% likely to have CCSVI found during the procedure.
Cece
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Re: Dr. Mandato at ISNVD

Postby Cece » Sun Jun 10, 2012 4:59 pm

http://www.isnvd.org/files/ISNVD_Newsletter.pdf
Dr. Kenneth Mandato reviewed data from a study done using the Zamboni protocol after angioplasty,
and concluded that CCSVI is not a true entity, however, correlation with ultrasound is strong.

CCSVI is not a true entity??? What's that mean?
Cece
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