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https://www.facebook.com/Dr.Arata

"Where do you balloon A, B, C or D (all)?" followed by an image of a CCSVI jugular

And Sandra Whitaker posted a link to this on Dr. Arata's page: http://stanfordhospital.org/newsEvents/ ... rders.html
A detailed article on autonomic nervous sytem dyfunction from Stanford university

I think that this post has more potential for pushing the knowledge curve personally;

Marilyn FrouFrouposted toMichael Arata

Hi Dr. Arata,
Just wanting your expert opinion on extracranial vertebral veins in Ccsvi. Do you find they are tortuous in ppl with CCSVI as opposed to non CCSVIers?
I have scanned well over 2000 carotid + vertebral arteries (non msers that I know of) noticing most had fairly straight arteries and veins. In the msers I have scanned, I have noted tortuosity of the same extracranial veins and arteries - mostly veins.
Have you noticed this trend?? In some I've seen, they almost looked like varicositis of the GSV.


Nigel Wadham Hi Dr and Marilyn, is there any indications what might cause this phenomenon?
At a guess or assumption it would be caused by a disease or infection process such as CPn infection or Lyme infection?


Nigel Wadham Continued over to Dr Salvatore Sclafani as well on TiMS;
http://www.thisisms.com/forum/post204629.html#p204629

DrSclafani answers some questions : Chronic Cerebrospinal Venous Insufficiency (CCSVI) - Page 508
www.thisisms.com
Dear dr. Sclafani, Just a brief questions about CCSVI procedure examination usin...See more


Nigel Wadham Giving this some thought there is another possibility here that could be considered.
If a Vascular problem started by CPn (which is a common vascular issue) creates infection and flow problems in the veins of the neck both leading into and exiting the ...See More


Marilyn FrouFrou What I've seen aren't collaterals, they were definately native vertebral veins running alongside tortuous vertebral arteries. They originate from SCAs bilaterally and run the same course as a non tortuous vessel.

Just saying, regards
Nigel

What does "varicosities of the GSV" mean?

What I've seen aren't collaterals, they were definately native vertebral veins running alongside tortuous vertebral arteries. They originate from SCAs bilaterally and run the same course as a non tortuous vessel.

The native vertebral veins are being used as collateral routes for the blocked IJVs in some patients. I have a very large left vertebral vein as a result of my left jugular having been 100% blocked.

I think she is using collateral to mean new veins that develop through angiogenesis. But we use it to mean any vein that takes over the flow. Dr. Zamboni had a good word for this, what was it? Shunts?

A new nosologic vascular pattern that is defined by chronic cerebrospinal venous insufficiency (CCSVI) has been strongly associated with multiple sclerosis. The picture is characterized by significant obstacles of the main extracranial cerebrospinal veins, the jugular and the azygous system, and by the opening of substitute circles. The significance of collateral circle is still neglected. To the contrary, substitute circles are alternative pathways or vicarious venous shunts, which permit the drainage and prevent intracranial hypertension. In accordance with the pattern of obstruction, even the intracranial and the intrarachidian veins can also become substitute circles, they permit redirection of the deviated flow, piping the blood towards available venous segments outside the central nervous system.

http://www.ingentaconnect.com/content/b ... awler=true
Substitute circles or collateral circles or vicarious venous shunts were the words used there.

Anyway these posts from Dr. Arata and Marilyn are the first I've heard of arterial involvement. We know there are tortuous veins. Are there also tortuous vertebral arteries? But not the carotid artery? Needs verifying.

Thanks Nigel, I saw you posted this over in Dr. Sclafani's thread too, it is interesting.

Hi Cece,
I am very interested in clarification on this like you.

I am thinking if there are tortuous arteries then one could 'assume' that they have decreased flow into the brain.
That then poses the question what is the input from 'MS' or 'CCSVI' Vertebral arteries compared with others (I am sick of the term Normal btw).
Are we looking at more pieces to the puzzle/ I think so, the bottom line is that because these are 'small' blood vessels as Sal has said they are down the list for inspection and understanding because of assess!

Imagine in a year or so how this will pan out ;)

Nigel

A year or so! We've been at it for years already. The randomized controlled trials are not guaranteed success especially with inexperienced IRs. I am frightened for us.

In the msers I have scanned, I have noted tortuosity of the same extracranial veins and arteries - mostly veins.
Have you noticed this trend?? In some I've seen, they almost looked like varicositis of the GSV.

Varicosities of the GSV = varicosities of the great saphenous vein
She says, "Mostly veins," so maybe there isn't much involvement of the arteries. The carotid would be the main one but she mentions vertebral arteries.

Dr. Arata has now done over 2000 CCSVI procedures. What do we make of that? Not enough data collected. He's gained experience. He mentioned in his post on where in the jugular should he balloon (a,b,c or all of them) that early on, he ballooned some patients in the upper jugular before learning not to do that because it is prone to vein injury and occlusion. When I was treated in 2011, that was one of the lessons Dr. Sclafani noted, that my left jugular had a narrowing in the upper jugular but that it was able to expand when I held my breath and pushed, so it did not need ballooning but other doctors might incorrectly balloon there. Dr. Arata claimed in his posts too to have seen a lot of other doctors ballooning these upper jugulars. Dr. Cumming a year ago during one of my follow-up ultrasounds mentioned that he is very very careful about ballooning in the upper jugular (I can't remember if he said that he does not do it all or if it is only very rarely).

If you've read Dr. Arata's post on the upper jugular stenosis over on Facebook, as a complement there is Dr. Sclafani's post on upper jugular lesions over on his website: http://www.ccsvicare.org/outreach_update01.html

Good point Cece
and I recall the stenting issues of upper Jugs as well. I don't know the difference between upper safe and upper not safe though!

The veins and arteries when vertical/standing have always in my opinion been the ones to focus on. The RR form of the disease is misleading the advancement of the CCSVI knowledge imo. RR appears to relate to lying down and the damage is done in that position/period of time, again imo.

Any relapse or re-inflammation or reactivation of existing damage is needing more understanding as to why. My favourite is of course a flare of diseases such as Bacterials. The vascular narrowings and valve dysfunction would have to be influenced by something! When this is fluctuating on and off so to say there needs to be more searching for WHY?

The flat line progressives aka me are more likely to provide insight to the basic disease process which everyone will achieve over time. The period of the up and down is a red herring and has attracted Pharmaceutics like flies!

They don't want to look any further, it is financially not in their interest and they will loose Customers if some bright person works outside of their net and finds reasons for MS and CCSVI.

It must be a HUGE threat to their Golden Eggs that there have been papers out by people such as Prof Ebers and others more recently!

I digress, the tortuous veins are a flashing alert to something important imo, the same way as Varicose Veins has been.

;)
Nigel

Not sure what the point of all this is, someone had a private conversation on Arata's FB?

He only believes in one treatment modality, valves are the problem, balloon valves, problem resolved, as is this were all so simple and easy to understand. Oh and that will be 5k for the crappy scans. I've seen them, wouldn't pay 100 dollars. Tired of seeing us MS patients getting taken advantage of across the board. Everyone stands up for the doctors, us patients are a mere afterthought.

There's a reason Mike left this venue, he cant take the heat. Or answer the questions that need answering. If he can come on here and explain one good reason for those crappy, mandatory 5 thousand dollar MRV's he charges for, well maybe my opinion will change.

As for now, screw all these people looking to make an easy buck.

Dr Michael has said a few more things on the thread;


It's a bit like being a Dentist pulling teeth though!

Mark, it's good to see you here again. I applaud you for posting what you believe.

I wonder--does Dr. Arata refuse to treat patients who don't want the MRV? He talks about having done 2,000 CCSVI procedures, but none of those were done using IVUS because he didn't want to invest money into acquiring (purchasing or leasing) the equipment. Please correct me if I'm wrong, but doesn't $5,000 x 2,000 = $10,000,000 TEN MILLION DOLLARS??? Seems to me he could easily afford to start to use IVUS. I feel so sorry for all his patients who paid all that money and didn't receive complete procedures.

Thanks HP, what I find is a 'risk' is to treat people with a one mind attitude.

It would blind an IR to what is happening within the 'whole CCSVI picture'.

When other IR's such as Dr Sclafani are finding 'missed' problems or 'undertreated or overtreated due to not using IVUS then that screams WARNING in my mind as well!

Who's task is it to upskill providers eg Synergy, especially when they are financially able to fund their own training as HP has pointed out.

;)
Nigel

NZer1 wrote:Dr Michael has said a few more things on the thread;


It's a bit like being a Dentist pulling teeth though!

Hi Nigel, the link doesn't work for me. Do you happen to have the text to post?

HP just for you

"Nigel Wadham; Giving this some thought there is another possibility here that could be considered.
If a Vascular problem started by CPn (which is a common vascular issue) creates infection and flow problems in the veins of the neck both leading into and exiting the brain then these flow issues will also effecting the CSF flow of the Brain.
There is also the likelihood of valve problems in the IJV, EJV as well as azygos.
If the CPn infection develops further and causes Tortuous veins in the VV's then there are more flow issues that will create symptoms. So a symptom cascade effect can occur, either intermittent or continuous progressive symptom group.
The Vagus nerve will be implicated because of altered artery, vein and CSF flow interactions which will complicate the picture of egg and chicken.
Any feed back would be gratefully welcomed


Marilyn FrouFrou; What I've seen aren't collaterals, they were definately native vertebral veins running alongside tortuous vertebral arteries. They originate from SCAs bilaterally and run the same course as a non tortuous vessel.


Shirley Renshaw; Thank you very much for your interesting findings Marilyn FrouFrou.


Marilyn FrouFrou; SCA/SCV..


Michael Arata; They are for example the vertebrals but collateral in sense that they carry far more than normal amount of venous return. I do not use Doppler so perhaps you see something different. A venogram only depicts what is filled with contrast.


Nigel Wadham; Michael you don't appear to be concerned by the 'tortuous' nature found in PwMS? To me it seems to be indicating some investigation and understanding would be of benefit in knowledge on CCSVI.


Michael Arata; Tortuousity of a vessel is a result of increased pressure, vein or artery.


Nigel Wadham; So is that something we need to be concerned about? I have the impression that any flow and or pressure if it is an artery changes feeding or draining the brain are often associated with the disease 'MS' and other de-generatives, is this what you understand as well?


Michael Arata; In general they diminish after jugular obstruction is relieved.

Nigel Wadham; Marilyn FrouFrou is that what you are finding or have read about? It would also be of interest to here from other IR's for their experience on this.
It sounds logical for an artery if there is resolving of exit flow problems but not for veins of a different circuit of the outflow. And it is also logical for the CSF flow to change if the tortuous veins 'diminish'.

Does Dysautonomia change/get cured if the IJV are ok and the Azygos is the only vein PTA'ed Michael Arata ?"

HappyPoet wrote:Mark, it's good to see you here again. I applaud you for posting what you believe.

I wonder--does Dr. Arata refuse to treat patients who don't want the MRV? He talks about having done 2,000 CCSVI procedures, but none of those were done using IVUS because he didn't want to invest money into acquiring (purchasing or leasing) the equipment. Please correct me if I'm wrong, but doesn't $5,000 x 2,000 = $10,000,000 TEN MILLION DOLLARS??? Seems to me he could easily afford to start to use IVUS. I feel so sorry for all his patients who paid all that money and didn't receive complete procedures.

The MRV is mandatory, I believe he does use IVUS. He treats all manner
of neurological diseases with PTA.

The MRV I looked at, was unintelligible. It was that bad. No stenosis were apparent, I wondered what the point was. It is required for treatment. I do believe he uses IVUS to locate the valves and obliterate them, that is the sum total of what he does.

I have another doctor, a genius level guy that reminds me of Dr Dake,
that is attempting another treatment method, non-invasive, will report as his results
come in, his patient has already been angio'd but it (good results) went away after two months.

He spent 2 hours one Saturday explaining things to me, and it made sense. Will report as it comes in.

CureIous wrote:I have another doctor, a genius level guy that reminds me of Dr Dake,
that is attempting another treatment method, non-invasive, will report as his results
come in, his patient has already been angio'd but it (good results) went away after two months.

He spent 2 hours one Saturday explaining things to me, and it made sense. Will report as it comes in.

Please do, I am interested in what this could be? It's a noninvasive treatment by an IR?
When the good results go away, the question is always if the veins are still open?
It might not even be restenosis if they're closed; it might be underdilatation/the stenosis was never effectively opened.

Over on CCSVI Locator, if you're a member and click on Dr. Arata's profile, you can easily read through all comments he has made over there: http://ccsvi-ms.ning.com/profile/Michae ... memberList

We are heavily influenced by Dr. Sclafani's techniques and ideas here. I find it fascinating to compare and contrast with what another active CCSVI IR is saying. As far as I know, Dr. Sclafani and Dr. Arata are the only two doctors currently engaging with patients in this way.

Mark, I'd be happy if Dr. Arata has started to use IVUS routinely, especially if he has the equipment:

Cece wrote:Here was a statement from Dr. Arata on IVUS. I think he is saying that he uses IVUS on a small percentage of cases that are more challenging, but does not use it routinely. Dr. Harris linked to an IRB that they are doing using a Volcano IVUS, which must mean they have one in the clinic now.

chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic17138-30.html#p169962

http://www.thisisms.com/forum/chronic-c ... ml#p178204

Cece wrote:

MarkW wrote:I have not added Interventionalists from SynergyHealthConcepts to my gold standard list. My understanding is that SHC does not use IVUS with every patient, prefering MVI/MRV.

MarkW

This is my understanding as well.

http://www.thisisms.com/forum/chronic-c ... ml#p178350