SIR Conference 2012

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

SIR Conference 2012

Postby Cece » Sat Mar 24, 2012 7:26 am

The IRs are meeting again, this time out in San Francisco!

Here are the relevant presentations happening today:
http://www.sirmeeting.org/index.cfm?do= ... Ev&ev=2531

The Art of Clot Removal I - Adjuncts to Lysis (Intraprocedural)
12:34 PM - 12:42 PM
Dr. Nael Saad, MD, Mallinckrodt Institute of Radiology, Wash University - Contact Me

The Art of Clot Removal II - Before and After Care to Improve Your Outcomes
12:42 PM - 12:50 PM
Dr. Carl Black, MD, Utah Valley Interventional Associates
An Overview of CCSVI
4:00 PM - 4:15 PM
Dr. Michael Dake, MD, Falk Cardiovascular Research Center
Endovascular Treatment of CCSVI: Technique
4:15 PM - 4:30 PM
Dr. Kenneth Mandato, MD, Albany Medical Center
Endovascular Treatment of CCSVI: Outcomes and Complications
4:30 PM - 4:45 PM
Dr. Richard Saxon, MD, FSIR, North County Radiology Medical Group, Inc.
CCSVI in Practice: The American Access Experinece
4:45 PM - 5:00 PM
Professor Salvatore Sclafani, MD, FSIR, American Access Care
CCSVI in Practice: The Synergy Health Concepts Experience
5:00 PM - 5:15 PM
Dr. Michael Arata, MD, Pacific Interventionalists
CCSVI in Practice: The Rhode Island Vascular Institute Experience
5:15 PM - 5:30 PM
Dr. Gregory Soares, MD, RI Vascular Institute
Panel
5:30 PM - 6:00 PM
Panelist(s)
Dr. Michael Arata, MD, Pacific Interventionalists - Contact Me
Dr. Michael Dake, MD, Falk Cardiovascular Research Center - Contact Me
Dr. Kenneth Mandato, MD, Albany Medical Center - Contact Me
Dr. Richard Saxon, MD, FSIR, North County Radiology Medical Group, Inc. - Contact Me
Professor Salvatore Sclafani, MD, FSIR, American Access Care - Contact Me
Dr. Gregory Soares, MD, RI Vascular Institute
From 4 pm to 6 pm, it's two hours of CCSVI. These professionals are not wasting their time. CCSVI is not bee stings. It is a vascular disease that they are able to image and treat and discuss and research.

With Dr. Sclafani unable to be there, I wonder if Dr. Kevin Sullivan of AAC Atlanta could step in to present on the American Access Experience.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 6:44 am

The twitter hash tag is #SIR2012 but so far nothing on CCSVI. If you're interested in CAS or CEA, there were minor comments about those. (Carotid artery stenting vs surgery.)

Here's an article that came out today:
http://www.marketwatch.com/story/interv ... 2012-03-25

Dr. Mandato discusses the findings that are published in this abstract in the Journal of Vascular and Interventional Radiology:
http://tinyurl.com/84wxx8m
"Results of the study were quite exciting and promising," stated Mandato. "We can attest to significant physical improvements reported in greater than 75 percent of those with relapsing remitting and primary progressive forms of multiple sclerosis. Additionally, mental health scores improved in greater than 70 percent of individuals studied. People with secondary progressive multiple sclerosis showed statistically significant improvements in both physical and mental health scores at a rate of 59 percent and 50 percent, respectively," he added.

Dr. Ferral also presented the results of his separate study: http://www.sys-con.com/node/2219441

From Carol Schumacher over on Facebook:
The CCSVI presentations at SIR were fantastic. Good synopsis of the state of affairs. Very pleased to see prominent neurologists paying attention. maybe collaboration is possible........
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Re: SIR Conference 2012

Postby cheerleader » Sun Mar 25, 2012 11:15 am

CCSVI Alliance is tweeting #CCSVI and #SIR

post from FB-
We have arrived in rainy (and cold) San Francisco for the SIR 2012 Conference. Attended a very informative CCSVI session this afternoon. Moderated by Dr. Gary Siskin, the presentations covered the early history of vascular research in MS (Michael Dake), treatment and efficacy (Dr. Saxon, Dr Arata), safety of procedure and efficacy (Dr. Mendato), patient expectations (Dr. Soerens), responsibility of treating doctors and current knowledge (Dr. Siskin). The use of ultrasound for diagnosis was a topic of interest, just as it was at the ISNVD. Treating doctors are experiencing a decrease in patient visits. They all mentioned the need for collaborative research.
Tomorrow we will be in the exhibit hall where we will have the opportunity to meet and converse with the medical and healthcare community.
For those in the San Francisco area, we hope to see you at the Alliance event on Tuesday night at the Marriott Marquis - go to www.ccsvi.org to register.


will try to get pics out.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 11:29 am

If treating doctors are experiencing a decrease in patient visits, does that mean that there are fewer new patients, or that each patient is having fewer visits meaning fewer repeat procedures?
Thank you for the update!
I've heard what many of the doctors had to say at other conferences, but not from Dr. Soares on patient expectations. My guess is that patient expectations are high and that the doctor needs to explain prior to the procedure that in some percentage of patients, there are no improvements. It gets back to patient selection, if they can determine who benefits or who does not.

Another tweet, from "interventional news":
Two researchers at #SIR2012 press conf say that relapsing remitting MS patients appear to benefit most from endovascular treatment.

Which researchers are saying this? Is it a small difference, such as 70% RR patients benefitting and 60% SP or PP benefitting? I remember something along those lines in the ISNVD abstracts.

Here is a video of Dr. Englander reporting from SIR about their study: http://www.sirweb.org/news/newsPDF/Englander.MP4

Dr. Timothy Murphy, presenting on some other subject, had this to say: ""IR...better, faster, safer medicine."
I will just explain to my neurologist, that my interventional radiologist is practicing better, faster, and safer medicine than he is.
I am sure that will go over well. :wink:
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 2:42 pm

tweeted by SIRmembers:
Dr. K. Mandato: in questioning-have #multiplesclerosis pts who come back day after #angioplasty w/ more energy, walk better, etc.
Dr. Ferral: 55% pts reported positive response to #angioplasty in those w/ venous blockages in those w/ #multiplesclerosis

Abstracts presented today:
http://www.sirmeeting.org/index.cfm?do= ... s&abs=2088
The Diagnostic Utility of Ultrasound for Chronic Cerebrospinal Venous Insufficiency (CCSVI) in patients with Multiple Sclerosis


View Presentation

Presented During: Venous Interventions I

Sun, 3/25: 10:54 AM - 11:02 AM

Authors:

J. G. Almond1, M. Englander1, K. Mandato1, S. Parikh1, G. Siskin1

Institutions:

1. Radiology, Albany Medical Center, Albany, NY, United States.

Purpose:

To evaluate the ability of ultrasound (US) to diagnose venous disease in patients with MS undergoing treatment for CCSVI.

Materials:

A retrospective analysis of all MS patients treated for CCSVI during an 8-month period was performed. The study population consisted of patients undergoing US of the internal jugular veins (IJV) within 24 hours of venography (CV). US was performed utilizing the protocol described by Zamboni, et al. A positive US met 2/5 criteria for CCSVI. A positive unilateral US met 2/4 criteria (without the transcranial evaluation of the deep cerebral veins). A positive CV was defined as one identifying a ≥50% stenosis in at least one vein, including the azygos vein. The US and CV findings were then compared.

Results:

416 patients were treated during the study period; the study population consisted of 310 patients (mean age 49 years; 30% male and 70% female). 224/310 patients (72%) had a positive US, and 155 (69%) of these patients had a positive CV; 86/310 patients (28%) had a negative US, and 66 (77%) of these patients had a positive CV (p=0.240). An ROC curve was generated (AUC=0.463). 300/310 (97%) patients underwent PTA of at least one vessel (215/224 with a positive US and 85/86 with a negative US) because venography showed either a ≥50% stenosis or a flow abnormality in association with a <50% stenosis; US therefore had a false negative rate of 99%. On the left side, 87/310 (28%) patients had a positive US, and 41 (47%) of these patients had a positive CV; 223/310 (72%) had a negative US, and 117 (52%) of these patients had a positive CV (p=0.472). On the right side, 63/310 (20%) patients had a positive US, and 28 (44%) of these patients had a positive CV; 247/310 (80%) had a negative US, and 130 (53%) of these patients had a positive CV (p=0.308).

Conclusions:

Findings on a Zamboni-protocol US are not associated with findings on contrast venography in light of the high false negative rate; 99% of the patients with a negative US had a significant stenosis and/or flow abnormality treated with angioplasty. A prospective study is needed to define the role of US and other modalities in the non-invasive diagnosis of CCSVI.

A high false negative rate means that they're finding patients who fail to meet the diagnosis of CCSVI on ultrasound but, when the patients go ahead and have the procedure done anyway, they turn out to have CCSVI as seen on flouroscopy used during the procedure.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 3:17 pm

http://www.sirmeeting.org/index.cfm?do= ... s&abs=2099
Findings on venography in patients with MS undergoing an evaluation for chronic cerebrospinal venous insufficiency (CCSVI): correlation with MS subtype and the presence of visual symptoms at the time of MS diagnosis.

Presented During: Venous Interventions I

Sun, 3/25: 11:02 AM - 11:10 AM

A. Bagherpour1, L. Kurian1, K. Mandato1, M. Englander1, G. Siskin1

Institutions: Radiology, Albany Medical Center, Albany, NY, United States.

Purpose:

To compare the findings on venography with clinical symptoms and subtype of Multiple Sclerosis (MS) in patients undergoing an evaluation for chronic cerebrospinal venous insufficiency (CCSVI).

Materials:

A retrospective study of all MS patients being evaluated for CCSVI during a 6-month period was performed. Findings on venography were classified based on the distribution of stenoses within the internal jugular and azygos veins, a system described by Bartolomei, et al. These findings were compared with MS subtype and with the presence or absence of visual symptoms at the time MS was initially diagnosed. Positive findings on venography included a ≥50% stenosis or a flow abnormality in association with a <50% stenosis in each studied vein.

Results:

318 patients were treated during the study period; the study population consisted of 251 patients (mean 49.4 years; 37% male and 63% female) with complete historical data available for analysis. The distribution of MS subtypes was as follows: 122/251 (49%) had relapsing remitting MS, 76/251 (30%) had secondary progressive MS, and 53/251 (21%) had primary progressive MS. 70 patients had visual symptoms at the time of initial diagnosis of MS (39 patients had visual symptoms alone; 31 patients had visual and other symptoms). Based on the previously described classification system for venography findings, 38/251 (15.1%) patients had a Type A pattern, 100/251 (39.8%) patients had a Type B pattern, 108/251 (43.0%) patients had a Type C pattern, and 5/251 (2.0%) patients had a Type D pattern. The findings on venography were not associated with MS subtype (p=0.5907) or with the presence or absence of visual symptoms (p= 0.0912).

Conclusions:

The presence of visual symptoms at the time of diagnosis, and the subtype of MS, are not predictive of the findings seen on catheter venography performed as part of an evaluation for CCSVI. This contradicts previously published findings and leads to questions regarding the role that CCSVI plays in directly causing the clinical manifestations of MS. A prospective trial assessing the ability of clinical findings to predict venography findings and treatment outcome is recommended.
Did this get discussed at ISNVD? We may have already known this. Subtype of MS does not predict what will be found during CCSVI investigation, nor does presence of visual symptoms at time of diagnosis. Dr. Zamboni in one of his early works found a connection between types of CCSVI (bilateral jugular stenoses but no azygous stenosis; azygous and unilateral jugular stenoses; etc.) and types of MS (RR, SP, PP). This contradicts those findings. IVUS was not used so it is possible that a percentage of azygous stenoses were missed.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 3:25 pm

http://www.sirmeeting.org/index.cfm?do= ... s&abs=2110
Optimizing azygous arch venography for CCSVI

Presented During: Venous Interventions I

Sun, 3/25: 11:10 AM - 11:18 AM

Authors:

X. Wang3, S. J. Sclafani1, 2

Institutions:

1. American Access Care, Brooklyn, NY, United States. 2. Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States. 3. Interventional Radiology, Peking University Cancer Hospital and Institute, Beijing, China.

Author(s)

Professor Salvatore Sclafani, MD, FSIR - View Disclosure
American Access Care
Brooklyn, NY

Purpose:

This study's purpose was to determine the optimum venographic imaging to portray the Azygous Arch, an important component in the evaluation of CCSVI.

Materials:

100 consecutive patients undergoing chest CTA for PE were reviewed to assess the azygous arch pathway. Twelve consecutive patients diagnosed with MS according to revised McDonald criteria underwent internal jugular venography, azygography and venoplasty. The visualization of AZY arch and its valves on anterior-posterior (A-P), left anterior oblique 15-25°(LAO), and left lateral (LL) projection were evaluated by two radiologists and correlated with IVUS.

Results:

On CTA the AZY arch presented as an “L” shaped structure in 91/100 cases as an 'S' shape in 9/100 patients. The angle of the anterior arch to vertical axis was -1.27±8.94°, the angle of posterior arch to horizontal axis was 14.22±22.61°. In all 12 patients with MS, the anterior arch was best visualized in lateral projection in all twelve MS patients. LAO projection superimposed the SVC on the anterior arch in 12 patients. In eleven of twelve patients (92%), the posterior arch was best visualized without overlap in the LAO projection. The lateral view superimposed the superior aspect of the ascending azygous vein on the posterior arch. All six abnormal anterior arch valves were best visualized in the lateral projection and were not well seen in LAO. Two of three posterior arch valves visualized on LAO were not seen on Lateral projection. Neither anterior or posterior valves were well seen in the anteroposterior projection.

Conclusions:

A frontal or frontal oblique view can adequately assess the ascending azygous vein, the frontal view is inadequate for evaluation of the aygous arch The LAO projection is the best projection to delineate the AZY posterior arch and the Lateral projection is the best projection to portray AZY anterior arch during venography.

It's technical, but technical details matter to the IRs, including what is the best angle to image the azygous. The frontal view is adequate for assessing the ascending azygous (the stick part) but inadequate to assess the arch. One portion of the azygous arch (posterior) is best seen on LAO projection and the other portion of the arch (anterior) is best seen on lateral projection.

Certainly as a patient I never wondered what angles or projections my doctor was using. But as a patient I want the doctor to get the best images, so he can make the best decisions.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 3:33 pm

http://www.sirmeeting.org/index.cfm?do= ... s&abs=2117
Intravascular ultrasound: key role in diagnosis of azygous arch causes of CCSVI

Presented During: Venous Interventions I

Sun, 3/25: 11:18 AM - 11:26 AM

S. J. Sclafani1, 2

Institutions:

1. American Access Care, Brooklyn, NY, United States. 2. SUNY Downstate Medical Center, Brooklyn, NY, United States.

Purpose:

The azygous (AZV) vein is an important component of the venous drainage of the cerebrospinal vasculature. It is the primary venous outflow for the spinal cord of the thoracic and lumbar spine and forms an outlet for cerebral venous drainage when there are outflow obstructions of the internal jugular veins (IJV) as seen in chronic cerebrospinal venous insufficiency (CCSVI). Detection of venous stenoses of the AZV is challenging because of artefacts due to mediastinal motion. Intravascular ultrasound does not suffer from this problem. The purpose of this study was to determine how often IVUS facilitates detection of AZV arch stenoses in patients with CCSVI.

Materials:

Thirty random patients with CCSVI detected by Neck and Transcranial Doppler ultrasound whose endovascular procedures detected AZV arch lesions were reviewed. In all patients IVUS followed venography. We retrospectively reviewed venography looking for stenosis, reflux and webs and IVUS looking for immobile valves, webs, or septum.

Results:

IVUS was abnormal in each patient. Immobile valves (30 patients), webs (1 patient) and septums (2 patients) were discovered. The most common finding on venography was reflux (19 patients) Stenoses were identified in 8 patients. Venography was considered normal, even in retrospect, in 8 patients.

Conclusions:

AZV lesions may be difficult to identify on venography. Findings are often nonspecific reflux of contrast media that does not allow precise angioplasty. IVUS appears to be the gold standard for the diagnosis of azygous causes of CCSVI.

In 8 out of 30 patients who had azygous lesions, those azygous lesions did not show up on venography. If any of those patients had gone to a doctor who did not use ivus, those lesions would have escaped detection, and the patient would have left not knowing that they still had CCSVI. Dr. Sclafani uses the word precise in his conclusions, which I think is an apt word, as the use of IVUS adds to the precision of the diagnosis and treatment of CCSVI. Eight out of 30 patients means that approximately 25% of people with azygous disease would have the type of azygous disease that would go undetected unless ivus is used. That is a high percentage.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 3:37 pm

http://www.sirmeeting.org/index.cfm?do= ... s&abs=2118
High pressure balloon angioplasty to treat internal jugular vein stenoses in patients with CCSVI

Presented During: Venous Interventions I

S. J. Sclafani1, 2, K. Zhang2

Institutions:

1. American Access Care, Brooklyn, NY, United States. 2. Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States.

Purpose:

The nature of Internal Jugular Vein (IJV) obstructions associated with chronic cerebrospinal venous insufficiency (CCSVI) is not well established, but it appears to be different from those stenoses caused by thrombotic recanalization, scarring, tumor encasement and access intimal hyperplasia. We sought to determine the balloon sizes and pressures that were necessary to attain complete distension of IJV obstructions in CCSVI.

Materials:

The records of all patients undergoing endovascular treatment of the IJV for CCSVI were reviewed. Angioplasty was based upon venographic findings such as stenosis >50%, stasis, reflux, collaterals or upon intravascular ultrasound (IVUS) findings, such as cross sectional area stenoses (CSA)>50%, immobile valves, septa, membranes,or webs. Balloon sizing was initially calculated by visual estimation, but converted to IVUS measurement of CSA. Inflation endpoints were elimination of balloon waist without recoil or exceeding rated burst pressure. Balloon size and maximum pressure were recorded. Complications were reviewed.

Results:

93% of 150 treated patients underwent angioplasty of 239 IJVs. 82% received bilateral IJV angioplasty. Balloons used were slightly larger in diameter on the right (avg. 15.8mm, range 10-20mm) than on the left (avg 14.4mm range 8-20 mm). Endpoint pressure requirements averaged 12.7 Atmospheres (range 4-25 atm) on the right side and 13.2 atm (range 6-23 atm) on the left side. There were three balloon ruptures, two occurred during removal from the sheath.There were three dissections, two perforations and ten thromboses (6.3% of treated veins). All but one dissection and one thrombosis occurred prior to using IVUS CSA for balloon selection. Complication rate of 16% using visual estimation was reduced to 1.3% using IVUS CSA measurements.

Conclusions:

High pressures are required to completely dilate the lesions of CCSVI. IVUS reduces risk of vein injury.

Complication rate of 16% using visual estimation reduced to 1.3% using IVUS CSA measurements.
Complications are things like tearing of the vein (dissection) and clotting. The reduction of complications is an important goal for our IRs, and ivus may be an effective tool to meet that goal.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 3:40 pm

Clinical Experience in the Management of CCSVI: Single Center Experience

Presented During: Venous Interventions I

Authors:

H. Ferral1, G. Behrens1, Y. Tumer1, T. Souman1

Institutions:

1. Radiology, RUSH University Medical Center, Chicago, IL, United States.

Purpose:

Describe our experience in the management of CCSVI in patients with multiple sclerosis (MS).

Materials:

This is an IRB approved retrospective review of 105 procedures performed in 94 patients (35 men/59 women) with MS between 06/2010 and 09/2011. Mean age was 47.8 years (26-67). All patients had MS by Mc Donald criteria. Clincal categories were: 50% (47/94) Relapsing remitting (RR); 34% (32/94) Secondary Progressive (SP); 6.3% (6/94) Primary Progressive (PP) and 6.3% (6/94) unknown. Procedures were performed under conscious sedation. Jugular (JV) and azygos (AV) veins were evaluated with selective venography and intravascular ultrasound (IVUS). Angioplasty was performed if venograms or IVUS confirmed greater than 50% decrease in luminal diameter or reflux. Stents were used to treat non-responsive lesions or occlusions. Patients were anti-coagulated for 10 days and Plavix was given for 6 weeks. Follow-up included JV ultrasound (US) one week post-procedure and clinic visits with MSIS scores every three months. Results are presented as percentages.

Results:

Venography and IVUS showed stenosis in 94.9% (89/94) of patients and were normal in 5.2% (5/94). Venous stenoses were seen in a total of 179 veins: both JV (n=28) [31.5%], both JV and AV (n=21) [23.6%]; one JV and AV (n=20) [22.47%]; one JV (n= 15) [16.85%] and AV (n= 5) [5.61%]. Angioplasty was performed in all abnormal veins. Stents were placed in 5/179 (2.8%) veins. Indications for stent were: azygos vein kink (n=3) and JV occlusion (n=2). Symptomatic improvement was reported by 48/89 (53.9 %) patients; questionable improvement: 15/89 (16.85%) and no improvement: 26/89 (29.2%). Improvement was highest in RR patients [28/47] (59.6%). Indications for repeat intervention were: JV thrombosis 3/89 (3.4%), restenosis on follow-up US 3/89 (3.4%) and recurrent symptoms 3/89 (3.4%). Complications included: JV thrombosis 3/89 (3.4%) and bleeding at puncture site in 3/89 (3.4%). One patient died 4 months after the procedure of an unknown cause.

Conclusions:

Our results confirm that venous abnormalities are common in patients with MS. Angioplasty is safe in these patients and provided symptomatic benefit in 54% of our patients.

This has definitely been discussed before and it is also in one of the press reports linked in an earlier post. But the conclusions are simple enough. Angioplasty is safe, venous abnormalites are common in pwMS, and angioplasty is effective in 54% of patients.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 7:17 pm

from twitter
Kieran Murphy on what IR does badly; Brachytherapy and biopsy. "Stenting for CCSVI could be a very bad idea," he said


This press release comes with images!
http://www.cisionwire.com/society-of-in ... s,c9232953
image #1 - doesn't Dr. Ferral have a great smile?
image #2 - this image shows plaque inside the vein, which is not the pathology in CCSVI; not a great image to have used
image #3 - looks like a fairly big balloon. Patient's head is turned, I think. Indeed there appears to be waisting.
image #4 - waisting is gone
image #5 - An ivus image! But in what ways is Dr. Ferral using ivus? The article does not explain.
image #6 - yikes, looks like an occlusion in the upper jugular, with collaterals going around it? Is this treatable?
image #7 - "hourglass appearance" in the upper jugular. this is making me curious about Dr. Ferral's pov on lesions in the upper jugular. Again the patient's head is turned to the side. The reference to an hourglass seems to be referring to the upper jugular, but it looks to me like there could be a blockage in the area of the valves. Would the best course of action be to treat in the area of the valves and then to check the upper jugular again, and to check the upper jugular out with ivus, and to determine between a true upper jugular stenosis and a physiological one? With the head turned, this could be a positional occlusion of the jugular by the skull base.
image #8 - is a tease. No image comes up.
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Re: SIR Conference 2012

Postby tzootsi » Sun Mar 25, 2012 7:29 pm

I understand that Dr. Sclafani couldn't attend - did someone else do his presentations?
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 7:33 pm

tzootsi wrote:I understand that Dr. Sclafani couldn't attend - did someone else do his presentations?

I don't know. My assumption has been that they skipped over them, which is a shame, because these three were all on the nuances of technique. My guess is that the workshop tomorrow would be able to go on without him, because Dr. Cumming, Dr. Ferral and Dr. Arslan were all scheduled to present at the workshop.

Unrelated, here's a quote from Dr. Ferral, from the article above:
“Our experience showed that 95 percent of the individuals we evaluated had venous obstructions, supporting the concept that venous lesions are common in individuals with multiple sclerosis,” said Ferral. “Based on follow-up that included ultrasound one week post procedure and clinic visits every three months, our results showed that people who have this treatment are not exposed to fatal risks. It is our belief that portraying venous angioplasty of the azygos and jugular veins as a high-risk procedure is a widespread misconception that needs to be addressed and corrected,” he noted.
Gotta agree with that. All the studies have been emphasizing the safety of the procedure and the lack of adverse events.

Wonder what this does...
https://vts.inxpo.com/scripts/Server.nxp
"Complimentary registration for virtual attendance"
It asks for institution or practice, but 'none' would be honest.
http://www.sirmeeting.org/index.cfm?do=cnt.page&pg=1158
Just because you won't be at SIR 2012 doesn't mean you have to miss out on the valuable learning and networking opportunites that the meeting has to offer.

Sign up here to view the Plenary Sessions which will be webcast live Sunday, March 25, through Wednesday, March 28. While viewing the webcasts you can also interact with other virtual attendees and even ask questions of the presenters! Be sure to complete your full profile after you register.
Are any of the 'plenary sessions' on CCSVI? How did I make it to age 36 without knowing what plenary means??
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Re: SIR Conference 2012

Postby PointsNorth » Sun Mar 25, 2012 9:49 pm

Cece,

THANKS for posting AND your commentary!

PN
Albany 2010. Brooklyn 2011
Calcitriol+D3 2013-
Hurry up and wait.
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Re: SIR Conference 2012

Postby Cece » Sun Mar 25, 2012 10:26 pm

Thanks, PointsNorth. It is good to know that I am not alone in this thread. :)
Cece wrote:image #7 - "hourglass appearance" in the upper jugular. this is making me curious about Dr. Ferral's pov on lesions in the upper jugular. Again the patient's head is turned to the side. The reference to an hourglass seems to be referring to the upper jugular, but it looks to me like there could be a blockage in the area of the valves. Would the best course of action be to treat in the area of the valves and then to check the upper jugular again, and to check the upper jugular out with ivus, and to determine between a true upper jugular stenosis and a physiological one? With the head turned, this could be a positional occlusion of the jugular by the skull base.

Dr. Sclafani discussed the management of upper jugular lesions once before, it's a thorough answer:
http://www.ccsvicare.org/outreach_update01.html

from twitter
Dr. M Hicks at #SIR2012: "IRs responsible for much of medical innovation & advancement of today's minimally invasive treatments."

Basically the recurring theme seems to be: IRs are awesome, and do awesome medicine.
As a patient, can't disagree.
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