Dr. Sclafani's CCSVI Case Studies

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

Dr. Sclafani's CCSVI Case Studies

Postby NHE » Thu Nov 14, 2013 7:20 am

To commemorate Dr. Sclafani’s thread, DrSclafani answers some questions, reaching 1,000,000 views, I have collected links to the CCSVI case studies he has shared with the ThisIsMS community. This is an amazing body of work in CCSVI from which many members have learned immeasurably. Note that discussion of the case study typically follows each post so be sure to read the subsequent messages.

Thanks goes to Cece who helped by writing the short descriptions for each case study.

More importantly, extra thanks goes to Dr. Sclafani for changing the lives of MS patients both as a doctor and teacher.

Note: If you're using the Prosilver theme, then some of the images may appear to be cut off. To view the entire image, right click on the image and select "View Image" or whatever similar option your browser provides. Alternatively, you can change the setting in the User Control Panel to use the Subsilver2 theme.


November 17, 2010
Discussion of an internal jugular vein excised from a patient with multiple sclerosis (images no longer available).

November 21, 2010
A variety of attempts to open up tight stenoses of the valvular area (images no longer available).

December 7, 2010
A particularly severe stenosis (images no longer available).

December 8, 2010
A hypoplastic jugular (images no longer available).

December 13, 2010
A case of an upper jugular hypoplasia and thrombus occurring and treated during the procedure.

December 19, 2010
A case study of azygos stenosis and incomplete vertebral veins.

December 22, 2010
A case study of bilateral jugular stenosis with the left jugular being extremely difficult to catheterize. A hypoplasia correction is attempted.

January 3, 2011
An azygos vein (images no longer available).

February 13, 2011
A case study that involves a phasic upper jugular narrowing, a double set of valves in the right jugular, and a very tight stenosis of nearly 100% (Cece’s turn).

April 17, 2011
A case of dramatic change in ability to recognize objects by touch instantaneously after CCSVI treatment.

April 23, 2011
A case where the use of IVUS conveys more information than venography alone.

May 1, 2011
A case of enlargement of the azygos vein.

May 2, 2011
A continuation of the case of the enlarged azygos. Abnormalities found include a valve stenosis in a jugular, a septum in the iliac vein, and a duplication of the iliac vein.

May 5, 2011
The completion of the case of the enlarged azygos, with the discovery of a septum that divided the azygos and allowed only half of the vein to be used for flow.

May 11, 2011
Pre-procedure ultrasound images show a fixed valve leaflet. Three months post-procedure, the leaflet is no longer visible (Cece’s turn).

May 11, 2011
A case of angioplasty of the external left jugular vein, under specific circumstances.

May 16, 2011
A patient’s third procedure results in an upper jugular stent placed, a septum in the lower jugular ballooned, and an azygos valve treated.

May 29, 2011
A case notable as the first interrogation of the renal vein for CCSVI. An azygos and a jugular septum are also seen, and an old thrombus is cleared from the upper jugular vein.

June 7, 2011
A procedure done using only IVUS for diagnosis and treatment, without the use of venography.

July 24, 2011
A case involving uterine fibroids, a physiological upper jugular narrowing, and a stenting of the azygos. Compressions of the iliac vein and the left renal vein are also present.

July 24, 2011
After a procedure in which only the Nutcracker Syndrome is treated, the patient experiences dramatic improvement.

July 30, 2011
A case that demonstrates the importance of correct balloon sizing to avoid underdilatation.

July 31, 2011
The mathematical explanation of how IVUS is used to determine balloon sizing.

August 7, 2011
A case of a prominent emissary vein, a stenosed jugular vein, and an obstructed subclavian vein. The criticality of balloon positioning is discussed.

August 13, 2011
A continuation of the obstructed subclavian vein case.

August 18, 2011
The completion of the obstructed subclavian vein case, now referred to as the case of the port stenoses, and an azygos dilemma.

September 23, 2011
A case of unusual guidewire placement.

September 25, 2011
Bridging a thrombosis with the guidewire enables a stent to be placed.

September 30, 2011
A case of classic Nutcracker syndrome.

October 9, 2011
A case of two people, mother and son, with similar venographic appearances and dissimilar clinical presentations.

October 11, 2011
A case of a patient with chronic headaches, concentration problems and fatigability but no diagnosis of multiple sclerosis.

December 13, 2011
A case that is illustrative of some of the complexity of CCSVI management.

December 14, 2011.
A continuation of the complex case. A phasic narrowing caused by pressure of the muscles of the neck is not ballooned, but a narrowing at the confluens of the IJV where there is residual valve tissue is ballooned.

December 15, 2011.
A continuation of the complex case. There is flow in the left jugular, but the flow is directed upwards instead of downwards.

February 12, 2012
This case illustrates that gonadal vein embolization secondary to renal vein stenosis can redirect flow into and augment cerebrospinal venous circulation, thus inciting or exacerbating CCSVI symptoms.

March 17, 2012
A case of a left jugular vein in which the flow did not originate from the brain. This case study is notable for the IVUS images and angioplasty of a vertebral vein.

March 21, 2012
A continuation of the vertebral vein angioplasty case. These are the IVUS images.

April 11, 2012
Images of the azygos vein from a prior procedure show a perforated azygos.

April 11, 2012
A continuation of the perforated azygos case, with an explanation on how to discriminate between the contrast in the proximal vein from the contrast that is in the vein below the obstruction in order to identify a stenosis.

April 11, 2012
Close-up series of images of a stenosed valve. The cusps of the valve fill up with retrograde flow, potentially obscuring the jet of forward flow at the center of the stenosis.

April 16, 2012
A case of a damaged azygos vein.

April 17, 2012
This case study shows a vein which previously went untreated but which can be seen on IVUS to be 70% stenosed.

April 17, 2012
An annotated image of the azygos that shows why it sometimes appears as if the catheter is outside the vein.

April 17, 2012
An undersized balloon was used in a previous procedure. This was determined by using the diameter of the clavicle bone to compare the size of the vein in the first image to the size of balloon in the second image.

April 23, 2012
An example of undertreatment and underdiagnosis.

April 28, 2012
Despite difficulties in diagnosis, an unusual angiographic appearance of uncertain cause, and a lack of clarity of the pathology, a great outcome comes from limited interventions.

April 28, 2012
Although there is no direct evidence by venography, a stenosis is present. Indirect evidence is seen in the contrast going through the sinuses and down the contralateral jugular.

April 29, 2012
A case of remarkable immediate improvement.

May 29, 2012
A case study of a 20-year-old patient that illustrates the more subtle presentation of CCSVI in the younger patient.

July 1, 2012
A case of very early restenosis.

July 24, 2012
A case of stents, missed lesions and congestion of the spinal veins.

August 11, 2012
A case of pelvic congestion syndrome and nutcracker syndrome without diagnosis of MS. Case studies of patients without a diagnosis of MS may help establish CCSVI as its own entity.

September 11, 2012
Vein disease in Lymes is dissimilar to that of MS. The key is in the IVUS images.

September 25, 2012
A case of a completely closed valve, a rendezvous procedure, a severely obstructed upper jugular, and a brachiocephalic stenosis.

December 15, 2012
A case of thrombosis seen at five-week follow-up. Stent is deployed restoring flow.

December 23, 2012
What might appear to be failed venoplasty is actually unsatisfactory treatment including missed diagnoses of stenosis and development of intimal hyperplasia in unnecessary stent.

January 6, 2013
A case with a deceptively large-appearing jugular, as well as a stenosis that would have been missed without dural sinus interrogation and a stenosis that would have been missed without the use of IVUS.

February 18, 2013
This case illustrates the usual values of IVUS for determining balloon size, but also the value of IVUS in a case of post treatment stenosis.

May 21, 2013
A case of recurrent valvular stenoses.

July 26, 2013
A case of an obstructed dural sinus.

May 14, 2014
Nutcracker syndrome of the left renal vein. Stenting relieves severe abdominal pain. Prior IJV underdilation retreated.
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Re: Dr. Sclafani's CCSVI Case Studies

Postby HappyPoet » Thu Nov 14, 2013 6:32 pm

Thank you DrS, NHE and Cece -- this list with links is fantastic!
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Re: Dr. Sclafani's CCSVI Case Studies

Postby Needled » Sat Nov 16, 2013 12:30 pm

Thanks so much Dr. S and NHE and Cece. What a great idea. This is an amazing collection of works. Each case is so different and brings something new to the table.
I know nothing about publishing, but isn't there some way to bring this collecion to the attention of a wider audience? You would think that other doctors and researchers would want to (literally) see and learn from your experiences. Surely patients aren't the only interested parties...

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