cah wrote:Thank you, EdW-uwo, for your detailed answers so far! Would you tell us a little bit more about what Drs. Simka and Dake told (about the procedure)? Is Dr. Dake running or starting a study?
I _think_ Dr. Simka said that in his practice, first they attempt to do a balloon angioplasty, and if that's not successful, they use a stent. He said that in his experience, follow-up Dopplers have been normal one month post-procedure for the most part. He was also of the opinion that MRV isn't as useful as other imaging methods because you can't visualize the actual lesion in the vein.
Dr. Dake spoke about a few different aspects of CCSVI. He seems to feel that there may be multiple pathways which cause blockage of the veins (e.g. some might be congenital malformations, some might be pressure on the vein from another structure in the head, etc.) but that either way, it doesn't matter when it comes to treatment. (One interesting thing he mentioned is something called May-Thurner syndrome, where the iliac vein in the groin area becomes obstructed by pressure from the iliac artery, which runs next to it. I won't go into the pathophysiology, but it appears that something similar could be happening in some cases of CCSVI, where the carotid artery compresses the internal jugular vein.) He emphasized that in his opinion, stents are often better than balloons because they can resist external compression, and have often worked when balloons failed to keep the vein open. He showed some nice images of the flow in collateral veins disappearing as soon as the stent was deployed.
There was some talk about the possibility of setting up a randomized controlled trial comparing Liberation or stent placement with a sham surgery, just to rule out a placebo effect, but there are a number of issues with it. First, it's hard to blind the treatment that a person would receive, because (apparently) you can actually feel the balloon expanding, or the stent being deployed, which makes it obvious that you've received the actual treatment, rather than the placebo surgery. Plus, there are also ethical issues involved in denying the procedure to the patients who are assigned to the placebo arm of the trial. This is something that obviously has to be worked on carefully before anything's done.
I'm not sure if Dr. Dake is running or starting a study, though he did present some results that looked impressive.