Re: DrSclafani answers some questions
Posted: Thu Oct 20, 2011 6:44 am
Reading every day, so pls keep it coming!
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GREAT suggestion! There are 20,000+ followers on Joan's page and so many crave, and need, good infornation.Cece wrote:...... Joan has repeatedly asked for those who are knowledgeable to pitch in and answer some of the questions in the CCSVI in MS discussion page. It might be a surprise if you answered that call!
It's being replaced with forums for pages, which is an improvement, and can import the existing discussions:HappyPoet wrote:Facebook is getting rid of discussions. If cheer hasn't been notified yet, she will be soon.
1.The patient had only improvements for one week post-op. Now she is in the pre-op condition, plus pain in the thrombus area.drsclafani wrote: It seems to me like the questions are slowing down greatly. Should I consider this a success?
but perhaps i should branch out to other media....
the treatment starategy of thrombosis depends upon
1. clinical effects
2. location of the thrombus
3. whether thrombus is occlusive or not
4. how old the thrombus is
5.how long the thrombosis is
6. whether there is room to manipulate catheters above and below the thrombus
7. whether there is an inherent coagulopathy
8. what caused the thrombus
9. what was the prognosis for the vein before the thrombosis
10. what are the risks of the intervention
as you can see this is going to be a long discussion.
Lets see if anyone is reading.
I don't know if it matters, but I am assuming she was put on those after the thrombosis was found, and had not been on them from the time of the procedure itself? This gets at the cause of the thrombosis, #8 on Dr. Sclafani's list, and if the cause was underanticoagulation. Clexane is lovenox, which is powerful, I know someone who had a bleeding complication requiring hospitalization because of it (but everything turned out fine). If she was on lovenox from the time of the procedure and still clotted, then it could be a clotting disorder or, as you said, overdilatation.pelopidas wrote:she has been on clexane 0.4 and sulodexide
she is a 28 yo woman about 55 kgr (120 pounds)
drsclafani wrote: It seems to me like the questions are slowing down greatly. Should I consider this a success?
but perhaps i should branch out to other media....
the treatment starategy of thrombosis depends upon
1. clinical effects
2. location of the thrombus
3. whether thrombus is occlusive or not
4. how old the thrombus is
5.how long the thrombosis is
6. whether there is room to manipulate catheters above and below the thrombus
7. whether there is an inherent coagulopathy
8. what caused the thrombus
9. what was the prognosis for the vein before the thrombosis
10. what are the risks of the intervention
as you can see this is going to be a long discussion.
Lets see if anyone is reading.
So we could say that the thrombosis has worsed her condition. She went from clinical improvement BACK to her previous condition. To me that is a clinical deterioration and increase in pain. I would manage the pain with whatever analgesic works. Ideally, I would want to diagnose why she deteriorated as soon as possible. While many patients either restenose or have loss of placebo effect, or thrombose. I want to diagnose a thrombosis as soon as possible because time is vein. The longer the duration of the thrombosis, the more damage to the vein, the more organized therombus, the less likely that it can be dissolved, catheterized, lumen restored.1.The patient had only improvements for one week post-op. Now she is in the pre-op condition, plus pain in the thrombus area.
I am not surprised. it seems that the left IJV is far more commonly undergoes thrombosis. Perhaps it is the angle of the axis of the balloon and the vein itself that increases the risk. I wish i could predict why this happens. It is difficult to enter the left jugular vein from below: That makes it harder to catheterize the thrombosed left IJV.2.Left jugular
occlusion is bad because it stimulates more thrombus. as long as there is flow. the opportunities to catheterize are greater. Also flow in the vein means that part of the wall of the vein is receiving blood flow and that intima has a greater chance to survive. When there is sufficient thrombus to stop flow, then the intimal layer loses its oxygen delivery and dies. This bodes poorly for re-endothelialization since intima creeps from existing cells to cover the denuded segment.3.Rather occlusive
That clot is getting organized and hard. the chances to dissolve it are quickly disappearing. The harder the clot, the more difficult it will be to get a catheter to traverse the clot.4.Two months old
the length of clot and whether the clot has extended up to the top of the neck are important. if the clot extends up the entire vein, it is more difficult to clear the clot. The bulk of clot means more difficulty in aspirating, dissolving or fragmenting the clot If the clot extens up too high in the neck, the ability to perform rendevous is more difficult.5 and 6.Unknown
are we sure? Was she tested for Leiden factor,Protein S and C deficiencies, antiphopholipid syndrome. . Thrombosis does not only come because of the angioplasty alone.7.Negative
as we said, there are too large a balloon? Did balloon rupture? was there a dissection? Was patient given anticoagulation during procedure? how many times was balloon inflated? for how long?8.Unknown (overdilation?)
That makes sense. it would seem that the vein is worth trying to salvage. If it had been a long hypoplasia, it might not have much value. and attempts to recanalize might have been fruitless and have unnecessary risks. possibly there are large collateral veins that drain away from the jugular vein.9.There was a valve issue, i guess that the prognosis was good
[/quote]10.Well, Doctor S, we all listen!
We have to retrospectively enter 750 patients already treated into the registry. the electronic registry is still being beta tested. Our new parent company plans to support the effort but the merger is still ongoing.Rosegirl wrote:Dr. Sclafani,
Perhaps you could update us on some issues:
Is the proposed data base of patients up and running yet, and if so, how many people have been treated? Of those, is there data on how many have been re-treated? Are any other useful statistics starting to emerge?
Although it is still relatively early to draw conclusions, does the 1/3, 1/3, 1/3 rule still seem to apply (equal numbers of patients who get great improvement, moderate improvement or no change)?
As you and your colleagues prepare to present your findings at the spring conferences, can you give us some idea of what topics are likely to be discussed?