DrSclafani answers some questions

[Cece]

ok, ok...

In the case from the stents thread that you started, did the patient have any relief of symptoms after being treated for the renal stenosis?

[pelopidas]

ok, ok...

In the case from the stents thread that you started, did the patient have any relief of symptoms after being treated for the renal stenosis?

saved by the bell , thank you Cece
sorry i left a mess in this forum, it was the one and only question i would address to Dr S and Dr Sch (the conceptualist) on that table.

[NZer1]

OK lets get back to work,
Dr. S how will we (PwMS) know when PTA has sealed our BBB and that there is hope of stopping progression?

[NZer1]

If the human body was a car,

With a bulge in the Left front tyre, you could probably drive for 5,000 km no problem

In a straight line

If you want to stop in a hurry or turn a corner at 100km per hour will that tyre hold?

What is difference when PTA'ing a potential vein issue?
Is it a problem and why?
Does the vein cause BBB breach?
Is there a way to measure or see the effect of an anomaly that causes the BBB breach?
That is where there will be a break through, the impetus that is required to push this to the next level, to get even politics to vote for treating the afflicted.

Who is it going to take to show that the BBB is closed again?
Miro Biologists?
What tests will be the proof we need?

IMO
Nigel

[Cece]

In your ISNVD interview you mentioned the possibility of attending a neurology conference. It seems like a way to even begin to cut through the hostility. The AAN conference would be a big one, and it's coming up at the end of April in New Orleans. Have you thought about attending? Or ECTRIMS next fall?

(Pelopidas, it was a good question, and I look forward to the day it can be answered, by neurologists and vascular specialists working together with a more complete understanding of the connection between MS and CCSVI! We especially need to know what is going on when people have MS relapses after having had CCSVI venoplasty that was successful and complete.)

[NormB]

Greetings Dr Sclafani and all,
Sorry if this post might be offtrack but I have this idea that keeps bugging me for its possibility. Since it seems to be a fact that blood flows in the jugulars are restrained somewhat by either valves or stenonis, why can't one have a
miniature blood pump installed at the highest point possible on the main jugular vein?
To be more explicit the pump would draw blood from the brain and assist the heart with
just enough pressure as to not impede the main heart valve function or it could pulsate like
the heart when it feels the small pressure from the brain vein. The pressure from the pump could circumvent the valves and inflate the stenosed vein. Am I out of logic with this approach?
I know this is explained in a very simplistic way and I am not medically inclined but I
have some experience in pumping fluids and seen similar with water pumps.
Another thing the pump would obviously have a backflow valve. Maybe being setup
in an OR environment with an exterior pump for a certain time (a week?) might shape the valves and or the stenosed veins back to their proper or original setting.

I know it is very off the track but just thinking aloud for the experts to entertain the possibilities.

Btw sorry for my thinking in french and writing in english.

Take Care All

Norm

[drsclafani]

OK lets get back to work,
Dr. S how will we (PwMS) know when PTA has sealed our BBB and that there is hope of stopping progression?

interesting how questions like this are asked now, compared to those asked less than one year ago.
on another thread it seemed to me that ISNVC meeting was criticized by some for being too research oriented. This question cannot be answered yet because there has not been sufficient research to answer this question.

[NZer1]

Thanks Sal, I think the best part of all is that these conferences are bringing minds together rather than how it is in the business world where competition separates minds.
The original impact of Dr. Zamboni's understanding had too much focus on the veins being opened as "the big picture", which it was at that moment in time, whereas now the big picture is the entire situation down to what is happening to every last cell so to say.
It is going to be some time yet IMO before the answers are all in. So much to learn in what seems like so little time!
So many things are unknown about this area of body function, so many big discoveries will be made, exciting times.
HOPEFULLY egos will be keep under control!
Keep up the brilliant work Doc.

[Cece]

a couple of questions from over in the stents thread:
http://www.thisisms.com/forum/chronic-c ... ml#p187506

Thank you Dr. Sclafani,
My first Dr. did my first procedure, my second Dr. did the next two procedures. Could my age have something to
do with restenosis? I'm 54. He found new stenosis in my vertebral veins and my LIJV restenosed twice. Can I
safely do a fourth before I even get stents (if needed)? I have no other health issues. thank you

dlynn

Dr. Sclafani, what are the long-term projected dangers of stents in the jugulars? What about higher in the neck? It kind of instills uncertainty within patients when some docs used to put stents and now they non-compromisingly don't!

Thnx

[dlynn]

Thank you Cece and Dr. Sclafani

dlynn

[NZer1]

a couple of questions from over in the stents thread:
http://www.thisisms.com/forum/chronic-c ... ml#p187506

Thank you Dr. Sclafani,
My first Dr. did my first procedure, my second Dr. did the next two procedures. Could my age have something to
do with restenosis? I'm 54. He found new stenosis in my vertebral veins and my LIJV restenosed twice. Can I
safely do a fourth before I even get stents (if needed)? I have no other health issues. thank you

dlynn

Dr. Sclafani, what are the long-term projected dangers of stents in the jugulars? What about higher in the neck? It kind of instills uncertainty within patients when some docs used to put stents and now they non-compromisingly don't!

Thnx

Purely thoughts here,
Even though it isn't openly said, is this a case of knowing if the BBB is being breached before doing PTA, the first time and again for any subsequent times?
It seems as we learn from the pioneers that there needs to be a cut off point for what is the minimum or allowable amount of blockage and collateral bypass that maintains a tight BBB!
And again knowledge of what is the must PTA issues!
And what cannot be improved for what ever reason.
There is no doubt patient - Dr. discussion, the difference is Internet - IR discussion to help foster an understanding of the bigger picture prior to committing to PTA.

Regards All,
Nigel

[pelopidas]

three things I know about my relapses in the past
1.every relapse was an acute and dramatic deterioration
2.it was partly reversible, although some of the new symptoms got permanent
3.it started by the time i was trying to get up in the morning, after a night's sleep on supine position

i think that my relapses were a clinical manifestation of my jugular valves' insufficiency


happy birthday Dr S!

[Cece]

It seems as we learn from the pioneers that there needs to be a cut off point for what is the minimum or allowable amount of blockage and collateral bypass that maintains a tight BBB!

Or what is normal cerebrospinal drainage, so that the abnormal can be defined.

Happy birthday drsclafani!

[drsclafani]

ok, ok...

In the case from the stents thread that you started, did the patient have any relief of symptoms after being treated for the renal stenosis?

still waiting for an answer to my questiona, although it is very early

[drsclafani]

Thank you Dr. Sclafani,
My first Dr. did my first procedure, my second Dr. did the next two procedures. Could my age have something to
do with restenosis? I'm 54. He found new stenosis in my vertebral veins and my LIJV restenosed twice. Can I
safely do a fourth before I even get stents (if needed)? I have no other health issues. thank you

dlynn

I do not think that age has much to do with this, although this has not been completely studied and clearly elucidated. I think restnosis is likely to be
1. restenosis of valves most of the time
2. stenosis of the angioplastied wall, either from tear of the wall, or ischemia of the wall

Thus i think it it has to do with elongated valves, excessive duration of angioplasty, excessive sized balloons off high pressure, smoking tobacco, inadequate treatment, inadequate diagnosis, inadequate anticoagulation

Dr. Sclafani, what are the long-term projected dangers of stents in the jugulars? What about higher in the neck? It kind of instills uncertainty within patients when some docs used to put stents and now they non-compromisingly don't!

Thnx

[/quote]

the risks of stents are thrombosis in the long run. stent fracture is another concern.
the really issue is what to do when angioplasty continues to fail. This is a reason for stenting.