MrSuccess wrote:adding costs to the already " pricey " CCSVI treatments , might not be the direction to be going. Lower costs and reduced risk of injury .... are my desire.
Mine too. Along with thorough and durable treatment. And proper follow-up care.
My long-term desire is for the researchers to get CCSVI accepted as mainstream, not alternative, treatment. Then it can be covered more easily under insurance and especially for Canadians. The priciness of the procedure shuts out so many people. IVUS adds to the cost of the procedure directly (IVUS catheters are used and disposed, at about $500 each if I recall correctly; the actual IVUS equipment is about $100,000 but that can be reused and may already be present at the hospital or clinic). It also adds to the cost indirectly: more time spent with IVUS means more doctor time spent, more nurse time, more building time, fewer patients can be scheduled.
But if reduced risk of injury is the desire, as it should be, we have some research showing this:http://www.ccsvicare.org/outreach_update03.html
Complication rate of 16% using visual estimation was reduced to 1.3% using IVUS CSA measurements.
To flip that, you can have an approximate 99% chance of no complications if IVUS is used, versus an approximate 84% of no complications if IVUS is not used. And complications carry a high risk: these veins can be lost permanently.
Ivus sounds interesting enough ... but .... I'm not convinced of it's value. What does it do ? Illustrate the shape of the internal vein ? Round , oval , square
One of the Laws of Hydraulics is that regardless of whatever size and shape a vessel is .... the pressure [ Pressure = resistance to flow ] remains equal.
When the balloon is inflated, the vein rounds out to accommodate the balloon, so it might seem that it's not necessary to know the shape of the vein, but it is necessary to know the CSA .... Cross Sectional Area .... anyway the idea is that you choose the size of the balloon based on the CSA. Too small of a balloon might be ineffective. Too large of a balloon risks vein injury. The goldilocks just-right size of balloon is large enough to create a hopefully durable opening of the vein but not cause injury.
The problem with the venogram used in CCSVI procedures is that you don't get a three-dimensional view of the vein, so you don't know if it's squashed (because veins can be easily squashed) so it might appear to be a big vein but it's squashed and is smaller inside than it appears from the straight-on view, or it appears to be a small vein but it's squashed in a different direction and is actually a bigger vein. Without the precise measurements from IVUS, it is hard to achieve the just-right balloon size.
CCSVI is founded on FLOW .
Show me how to measure bloodFLOW.... INTO the brain ... and then .... OUT of the brain , and then you have something.
CCSVI was founded on flow which is why Dr. Zamboni called it an insufficiency, but there has been more recent ideas that it is more of a hypertension than an insufficiency. It may be that these outflow obstructions affect the incoming flow by a small degree, but that the big effect is the creation of focal points of elevated pressure within the capillaries. These focal points of hypertension cause all sorts of mischief. And then when talking flow we also have to talk about cerebrospinal fluid flow.
jeez that's a long response.
CCSVI is fascinating to me. Because of my personal improvements and also because of the hope I have that this will benefit others on a large scale as it has benefited me. I hate the controversy. I just want CCSVI researched. If the use of IVUS means better results, then I want IVUS used in the research, and used clinically as we all rush off to have it done without waiting for the research.