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Liberation wrote:

i am sorry, Liberation, in truth, the images that you show are so bad that one cannot really make accurate comments about them. There do appear to be segmental narrowings (?hypoplasia) but the area of the valve is not visible at all. Also you state that a 6x20 balloon was used. seems rather short, possibly rather thin. Might i guess that your IR was a cardiologist? just a guess and with no bias intended.

Almost, the head of the CCSVI program is a vascular surgeon. I have a great respect for him, just like I do for you. I just heard from him that they try to do dilation four times a year to avoid stenoses.

That is true that the upper parts are not indicated in the images. Could it be that they did not see those parts?

I think we should always try to see the ENTIRE vein, and, ideally, see the connection between the dural sinuses in the head and the jugular veins in the neck. Just last week i had a case of segmental hypoplasia which did not show reflux into the head. I sent the patient for a BRAIN MRV (not MRV of neck) and it showed clearly a number of dural sinus stenoses.

It seems to me me that they not treated the upper part of the IJV in the past as I just heard that they start dilating IJW all the way from now. Was it thought more dangerous treating the upper part? I guess there must have been a reason why they did not do it in the past.

If I understand correctly mostly valves are the cause of stenosis.
I try to get the MRV images that were prepared half a year before my operation those should be much better quaility.

ok. but perhaps your scan of your venogram is the problem. do you have the images? or do you have paper prints?
MRV just isnt as good as venography, but perhaps that will help us all understand what you are trying to show us.

Yes, I only got the print of it and the bad quality is due to my scanning. I have the MRV of the brain and the cervical. I can send you an access to a link where you can look at the full CD. Your help is greatly appreciated

Cece wrote:

drsclafani wrote:cece
just because you think that the narrowing is scar tissue, doesnt mean it is. In fact, i do not think it is when the narrowing is in the vicinity of the valves.
i was just making the statement that most IRs believe it is scar until proven otherwise and thus are over dilating.

I think it is not and have backed off on sizeing balloons to conform to the diameter of the vein to start.

I see what you were saying, you were talking about the original stenoses.

In a different scenario, we are hearing reports of patients who have scarring as a result of the procedure. Depending on what is exactly going on with those patients, as long as the vein does not close completely, it can still be ballooned again? I had thought scarring sounded so severe, this would not be possible.

sent the patient for a BRAIN MRV (not MRV of neck) and it showed clearly a number of dural sinus stenoses.

What next, for such a patient? Will the dural sinus stenoses be treated and by whom?

HappyPoet wrote:Hi Dr. Sclafani,

A very happy update for you!

My follow-up US showed strong flow throughout my left femoral vein which had been occluded by clot [from 1st procedure, different doctor].

Your post-procedure protocol of using Arixtra dissolved the very scary clot (DVT) and saved my leg and my life for which my family and I can never thank you enough. You will be forever in our hearts.

Thank you for everything, Superstar.

Liberation wrote:

perhaps you are misunderstanding dr cumming
I agree that one should not use extra large balloons in the upper IJV because it will be a mis-sizing and ballooning may cause more harm that good WITH A BALLOON THAT IS TOO LARGE. Doesnt mean that using a properly sized balloon cannot improve flow in the vein.

Is my understanding is correct that with your technique you still benefit from using large balloons but without (at least less) the risk of using large ballons?

Cece wrote:

Liberation wrote:

perhaps you are misunderstanding dr cumming
I agree that one should not use extra large balloons in the upper IJV because it will be a mis-sizing and ballooning may cause more harm that good WITH A BALLOON THAT IS TOO LARGE. Doesnt mean that using a properly sized balloon cannot improve flow in the vein.

Is my understanding is correct that with your technique you still benefit from using large balloons but without (at least less) the risk of using large ballons?

Liberation, I am an example, he used an 18 mm balloon on my right jugular which would be considered one of the extra large balloons except that he measured with ivus and it was rightly sized for that vein.

drsclafani wrote:we will be consulting a neurointerventionalist who has considerable experience with dural sinus stenosis that causes hydrocephalus. He is a disbeliever in ccsvi. he will remain anonymous for obvious reasons.

Cece wrote:

drsclafani wrote:now back to treatments full time yeah!

double yeah

drsclafani wrote:If you think that the narrowing is due to scar tissue you will try to overdilate intentionally about20% to maximize the stretch of the scar.

Didn't know you could stretch scar tissue in these veins. That is encouraging as well.

WeWillBeatMS wrote:Dr. Sclafani,

What vein or veins are normally responsible for draining the ears?

I suddenly lost my hearing in my right ear in 2003, a year and half before the diagnoses of MS. I am left with dizzyness and tinitus from my right ear. Multiple ENTs offer no help or hope. In the past year or so I notice my left (good) ear feeling plugged at times, especially at night while trying to sleep. I'm hoping that the Liberation procedure will help me in that area.

Thank you,

WeWillBeatMS

pklittle wrote:

Cece wrote:

Liberation wrote: Is my understanding is correct that with your technique you still benefit from using large balloons but without (at least less) the risk of using large ballons?

Liberation, I am an example, he used an 18 mm balloon on my right jugular which would be considered one of the extra large balloons except that he measured with ivus and it was rightly sized for that vein.

I am so confused.. is the current theory that ccsvi is a valve problem or not?

newlywed4ever wrote:Dr Sclafani,
I sent an email to you yesterday but your (pending) answer may also be of interest here. You treated my right IJV in the region of the confluence(left IJV was occluded/thrombosed since first angio which was treated by another dr). I am now experiencing swelling and tenderness on the right side of my neck. Normally, I would just think I have swollen glands but I'm a bit more concerned since I already have reduced blood flow due to LIJV. How concerned should I be? I have my 3 mo. f/u with Dr Makris 5/3/11... thanks!