Lots to think about here. Thank you, cheer, for posting the section from the paper itself. There is a big distinction if we are thinking of CCSVI as a disease of the valves or a disease of the veins and valves.
The altered collagen is found even distal to the the sites of venoplasty. Venoplasty usually covers the bad valve itself as well as a stretch of vein above the valve; although the balloon can be situated so that the shoulder hits the healthy vein just above the valve, this is not common practice. So we are talking about altered collagen that is some distance from the valve. It is not age-related because the comparison veins were from 80-year-olds and the MS veins were from 30-year-olds, and we were the ones who had the altered collagen in our veins, and those spritely 80-year-olds did not. We might have systemic involvement of connective tissue? That's a concern. These collagen abnormalities in the veins are not likely to be secondary to the inflammation of MS, because no inflammatory cells were seen.
Valves themselves are made of collagen, so a systemic collagen disorder could be expected to involve the valves:
In 200 dissections of internal jugular veins, the valves were investigated with regard to their constitution, their macroscopic and their microscopic anatomy. In 88% of the cases, an ostial valve was found. The cusp of each consists of two parts in 77%, of only one part in 16%, and in 7% of three parts. In 12% these valves are not found. The structure, the configuration, the topography of these valves are explained. The stroma of the valve consists of collagen and elastic fibrils. The surface of the luminal and parietal part is covered by endothelial cells with elastic and muscular fibers close to the attachment of the cusp to the vein wall.
If an internal jugular vein has abnormal collagen ratios, does ballooning soften the vein? If we are dealing with venous disease and not just valvular disease, then perhaps centering the balloon on the valve is better than off-positioning to minimize stretch of the healthy vein by placing the shoulder of the balloon just past the valve. Centering the balloon would stretch the vein itself more. Maybe ballooning the length of the IJV could give some benefit. Remember the research from Taiwan showing that patients who have migraines have reduced distensibility in their veins; if we have an altered collagen ratio, that should mean reduced distensibility in our veins with possible neurological sequellae. But as Dr. Sclafani pointed out, the vein does exhibit distensibility or dilatation right above the stenosis.
Maybe there will be another paper forthcoming that looks at the valves themselves. I am not opposed to talking about venous disease and valvular disease separately if there are observations to be made on both.
Sorry for the long post. I am going to look up systemic collagen disease and see what else that could involve.
Could the dilation above the valvular stenoses result in deposition of Type III collagen?
If so then it would not be likely to be a systemic collagen disease. This would be better news.
It is not good if Dr. Zamboni is proposing this to be a systemic collagen disease and that can be proven wrong. It might cast doubt on his other conclusions and on CCSVI itself. I don't know if the chronic effects of the deranged hemodynamics due to the outflow obstruction could lead to typeIII collagen deposition. I will look for what I can find on this.