what are the likely interventions?

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what are the likely interventions?

Postby Arcee » Thu May 21, 2009 1:44 pm

Hi All -

I've been wondering about what the possibilities are for interventions if the MRV does show problems. I apologize if this information is detailed in one of the earlier threads, but I think when I was reading those I wasn't understanding things as well as I am now.

So Jeff and Marie had similar surgeries and stents, but it sounds like it could be, likely will be, different for others of us. We'll each be having conversations with Dr. Dake about it, but this forum is just so helpful I wanted to toss the question out: what do we think the potential options are? There's the host of suggestions from Cheerleader's endothelial paper, and there is the surgery and stents like Marie and Jeff, but what lies in between? Non-stent interventions?

Thanks for puzzling through this,
Randi
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Postby peekaboo » Thu May 21, 2009 2:45 pm

I believe Wobbly posted somewhere that his veins got cleaned out..putting in a stent was inviolation of copyrights/standards US approved vs EU approved...
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Re: what are the likely interventions?

Postby Hub » Fri May 22, 2009 1:55 pm

Arcee wrote:I've been wondering about what the possibilities are for interventions if the MRV does show problems..... There's the host of suggestions from Cheerleader's endothelial paper, and there is the surgery and stents like Marie and Jeff, but what lies in between? Non-stent interventions?


Randi,

My understanding is that there are two types of possible invasive interventions: venous angioplasty with stents, and venous angioplasty without stents.

Here's the first result on Google if you search for venous angioplasty:

A Venous Angioplasty is a non-surgical procedure, which can be performed during a venogram to open or bypass narrowed veins to prevent clotting. Venous angioplasty can also be used for placement of a stent, which keep a vessel or tissue in an open position to allow bypass of scarred tissue and improve blood flow.

For a venous angioplasty procedure, a venogram (procedural x-ray of veins) is performed. Once blocked or narrowed vessel(s) are visualized on the venogram, a balloon tipped catheter is inserted into the blocked vein and guided under fluoroscopic x-ray to the area of interest. The balloon inflates to correct the blockage and enable blood flow. In some circumstances, a stent is put on the balloon tipped catheter. When the balloon is inflated, the stent is expanded and sticks to the walls of the blood vessel to keep it open.


You asked in another thread about published results using these interventions. Unfortunately, the only published results I'm aware of, in the context of MS, are the TIMS users who have posted their experiences. Both Jeff and Marie had venous angioplasty with stents, while Wobbly had venous angioplasty without the use of stents. Cheerleader suggested that Dr. Zamboni might not have been able to use stents with Wobbly because of legal issues, but it seems possible that not all PwMS will need stents.

Outside the context of MS, I'm not sure how often doctors have performed angioplasty (w/ or w/o stenting) on the internal jugular veins and azygous vein (or what the results have been). As far as I'm aware, no one has posted any such information on TIMS, and quick Googling hasn't proved too successful for me.
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Postby Hub » Fri May 22, 2009 2:28 pm

For additional information on balloon angioplasty and stents, you can read through Dr. Dake's patents:

http://www.patentstorm.us/inventors-patents/Michael_D__Dake/1010475/1.html

It seems as if the stents might also serve as drug-delivery systems to prevent restenosis.
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Postby Hub » Fri May 22, 2009 3:31 pm

Sorry for the multiple posts, but I want to add a link to a PhD dissertation on the effects of exercise on post-angioplasty restenosis. The dissertation focuses on coronary artery angioplasty, but it provides a good background on balloon angioplasty, drug eluting stents, and restenosis, and this background information should generally also be applicable to venous angioplasty of the internal jugular and azygous veins.

Link:

http://edt.missouri.edu/Summer2008/Diss ... search.pdf
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Postby cheerleader » Fri May 22, 2009 3:54 pm

Thanks for the links, Hub.
Some people may just need a little widening of the venous pathways with a balloon procedure (that's the temporary clean up Wobbly referred to). That wasn't really an option for Jeff, since his jugulars were occluded. The only way to keep them open was with the permanent metal stents.
The good news is that venous stents are more easily incorporated into the body than arterial stents, because they do not have to deal with pressure and pulsing blood from the heart. Veins in the head do not have to squeeze to get blood back to the heart (like in the legs) they just use gravity. Less motion in the vein means better patency.
Every patient will be different. Jeff's staying on his endo health program, exercise and supplements (no mountain biking until he's done with coumadin- falling is not an option on the blood thinners. Too dangerous.) We're hoping this will keep the veins open and flowing, and allow for healing.
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Arcee » Sat May 23, 2009 9:28 am

Hub, thank you so much for the detailed response. And Cheerleader, as usual, your contribution is clarifying. I'll keep studying up and will be well prepared about the possibilities by the time I go to Stanford.

I'll be sharing the information with my neuro. I think it's really interesting that he is completely on board with the MRV (and the argument behind it), and it will be interesting to see how he responds to the limited outcome data in MS patients regarding interventions. Unclear what the thinking will be about applying findings from other scenarios. Will let you know, as perhaps it will help other discussions with neuros.

Thanks again!
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