drsclafani wrote:SLOWFLOW If there is resistance to outflow from the brain, this may lead to reduced inflow to the brain. That may lead to reduced oxygen delivery to the brain and cellular function may be compromised without oxygen. and it may ultimately be the cause of deminished brain size. Perhaps it is improvement in blood flow after angioplasty that explains the very rapid improvements in neurofunction that some patients experience. Clarity, return of sensation, etc sometimes are seen before leaving the hospital. Of course it could be placebo, but it could also be improved brain function because of improved brain flow.
namely the debate of stenting and angioplasty. Firstly, we do not have ideally designed stents, there are concerns about migration because of the dynamic and considerable ability of these veins to dilate, and we do not have clarity of their long term outcome. It is therefore reasonable to attempt angioplasty first as it is safe and relatively simple. Repeating it is not a problem as the risk of the procedure is low.
Therefore I am inclined to treat by angioplasty alone first. See how things go. if symptoms recur, if stenosis recurs, then comes the decision making process that must be a plan devised by patient and doctor. If a patient's symptoms have imroved after angioplasty, cog fog, numbness, etc, then the decision is really a quality of life issue.
Folks, I am very much aware that since we as PwMS are in a way immunised against our own CNS, where activated T-cells continue to transmigrate across the deep brain & spinal cord venule epithelial layer, we therefore continue to battle the consequences of not only previous but also ongoing immunologically induced neurological damage.
However, I am confident that the venoplasty procedure is effective in improving our quality of life by increasing 1. CNS blood outflow and inflow to more normal levels; and 2. by minimising further exposure of the CNS to leaky vasculature, thereby reducing BBB compromise and therefore immunological cascades & CNS tissue damage.
I am also very much aware of the potential post-procedure placebo effect phenomenon, and whilst actively reducing my own expectation of improvements I am also asking for external observations, which would be of more significance than our more subjective self-reporting.
If we can report observations made by third parties, such as "..I can see that when you walk now you are lifting your foot higher." perhaps we can add that sort of information to the clinical notes of Prof Thomson and/or our neurologists , GP's etc to provide a clearer picture of our experiences..Just a thought.