angioplasty alters bp favourably

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

angioplasty alters bp favourably

Postby gibbledygook » Fri Nov 22, 2013 9:01 am

Phlebology. 2013 Nov 19. [Epub ahead of print]
Blood pressure normalization post-jugular venous balloon angioplasty.
Sternberg Z, Grewal P, Cen S, Debarge-Igoe F, Yu J, Arata M.
Source
Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA.
Abstract
OBJECTIVE::
This study is the first in a series investigating the relationship between autonomic nervous system dysfunction and chronic cerebrospinal venous insufficiency in multiple sclerosis patients. We screened patients for the combined presence of the narrowing of the internal jugular veins and symptoms of autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping disorders, headache, thermal intolerance, bowel/bladder dysfunction) and determined systolic and diastolic blood pressure responses to balloon angioplasty.
METHODS::
The criteria for eligibility for balloon angioplasty intervention included ≥50% narrowing in one or both internal jugular veins, as determined by the magnetic resonance venography, and ≥3 clinical symptoms of autonomic nervous system dysfunction. Blood pressure was measured at baseline and post-balloon angioplasty.
RESULTS::
Among patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction. Balloon angioplasty reduced the average systolic and diastolic blood pressure. However, blood pressure categorization showed a biphasic response to balloon angioplasty. The procedure increased blood pressure in multiple sclerosis patients who presented with baseline blood pressure within lower limits of normal ranges (systolic ≤105 mmHg, diastolic ≤70 mmHg) but decreased blood pressure in patients with baseline blood pressure above normal ranges (systolic ≥130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline blood pressure subcategories were observed.
DISCUSSION::
The coexistence of internal jugular veins narrowing and symptoms of autonomic nervous system dysfunction suggests that the two phenomena may be related. Balloon angioplasty corrects blood pressure deviation in multiple sclerosis patients undergoing internal jugular vein dilation. Further studies should investigate the association between blood pressure deviation and internal jugular veins narrowing, and whether blood pressure normalization affects Patient's clinical outcomes.
KEYWORDS:
Balloon angioplasty, CCSVI, blood pressure deviation, dysautonomia, gender differences, high pressure baroreceptors
PMID: 24255092 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/24255092
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Re: angioplasty alters bp favourably

Postby ThisIsMA » Sat Nov 23, 2013 2:59 pm

Wow, that is a really encouraging study. Not only the blood pressure normalization after angioplasty, but also the fact that the study found that:

Among patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction.


I wonder what they are doing differently to find such a high rate of stenosis compared to the studies that find 0% stenosis?

Thanks for posting this.
DX 6-09 RRMS
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Re: angioplasty alters bp favourably

Postby Cece » Sat Nov 23, 2013 8:10 pm

ThisIsMA wrote:I wonder what they are doing differently to find such a high rate of stenosis compared to the studies that find 0% stenosis?

The full study is available: http://phl.sagepub.com/content/early/20 ... 12824.long
The study involved MS patients who visited the Endovascular Clinic (Synergy Health concepts, Newport Beach, CA) between 2011 and 2012. Patients were screened for the combined presence of IJVs narrowing and symptoms of ANS dysfunction. BA was offered to patients who were diagnosed having ≥50% narrowing in one or both IJVs as confirmed by MRV (Siemens 3T TRIO scanner, Siemens Medical Solutions USA, Inc. 51 Valley Stream Parkway, Malvern, PA), which was based on the Haacke protocol (http://www.ms-mri.com/docs/ms-report-in ... mh-9pm.pdf), and by the documentation of three or more symptoms of ANS dysfunction, which were assessed using CCSVI symptom sheet.

They were doing Haacke MRVs. Were any of the 0% studies doing Haacke MRVs? I can't keep all the studies straight anymore.
Definitely encouraging research, and it's the first in a series by Dr. Arata focusing on autonomic dysfunction.
A drawback of the study was mentioned in the conclusion, which is that blood pressure can normalize after 24-48 hours, so there's no way to know if this is a persistent effect without repeating blood pressure measurements at a follow-up visit later on. The measurements in this study were taken 24 hours after venoplasty.
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Re: angioplasty alters bp favourably

Postby gibbledygook » Sun Nov 24, 2013 4:24 am

Well my blood pressure is now much higher than it was before the angioplasty but perhaps that is because I am much less fit and more disabled!
3 years antibiotics, 06/09 bilateral jug stents at C1, 05/11 ballooning of both jug valves, 07/12 stenting of renal vein, azygos & jug valve ballooning,
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Re: angioplasty alters bp favourably

Postby cheerleader » Sun Nov 24, 2013 10:58 am

I have a couple of concerns about this study-- agree with Cece.

They only followed patients for 24 hours after the procedure. How can they say the changes in BP or bladder are due to autonomic dysfunction?

We see the same changes in BP and urine output in those who are stented for vena cava syndrome, and it's not because of the vagus nerve, it's because of better blood flow and hemodynamic changes.
http://www.ajronline.org/doi/full/10.22 ... .3.1780635

It's seems like a pretty big leap to say this is because of the vagus nerve.
Why can't we simply be treating venous stenosis, improving blood flow and CSF levels, and leave it at that?
Jeff never had any BP issues or changes before or after his treatment, he's always had great cardiac health. But he sure did have better venous return and a working dural sinus and jugular on his left side. As Dr. Dake said, the changes Jeff experienced reminded him of improvements he saw after treating vena cava syndrome. The whole one-time hit/ TVAM thing is concerning, especially since there is an approved treatment already, which involves ongoing electrical stimulation-
http://www.mayoclinic.com/health/vagus- ... on/MY00183

cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: angioplasty alters bp favourably

Postby Cece » Sun Nov 24, 2013 4:27 pm

cheerleader wrote:We see the same changes in BP and urine output in those who are stented for vena cava syndrome, and it's not because of the vagus nerve, it's because of better blood flow and hemodynamic changes.
http://www.ajronline.org/doi/full/10.22 ... .3.1780635

It's seems like a pretty big leap to say this is because of the vagus nerve.

Agree with Cheer.
Some of my improvements were 'autonomic' improvements, so I am interested in this research and if it can be duplicated elsewhere, and if these improvements are considered important enough to warrant having the procedure. Sweating is an autonomic improvement, which aids in ability to tolerate heat, but not everyone gets that improvement or even has a problem with lack of sweating initially.
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Re: angioplasty alters bp favourably

Postby drsclafani » Mon Nov 25, 2013 10:19 pm

Cece wrote:
cheerleader wrote:We see the same changes in BP and urine output in those who are stented for vena cava syndrome, and it's not because of the vagus nerve, it's because of better blood flow and hemodynamic changes.
http://www.ajronline.org/doi/full/10.22 ... .3.1780635

It's seems like a pretty big leap to say this is because of the vagus nerve.

Agree with Cheer.
Some of my improvements were 'autonomic' improvements, so I am interested in this research and if it can be duplicated elsewhere, and if these improvements are considered important enough to warrant having the procedure. Sweating is an autonomic improvement, which aids in ability to tolerate heat, but not everyone gets that improvement or even has a problem with lack of sweating initially.


cece

i think that anhydrosis is one of the most common complaints seen in the patients who have consulted me. While some patients do have increased sweating after the procedure, I would not say that this symptom is commonly improved.

Generally blood pressure assessments are best done by automated blood pressure cuff in the sitting position after five minutes of rest in a two week cycle once or twice per day averaging 3-5 readings 1 minute apart.

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