Restenosis is a matter of when not if--According to this expert

April 6, 2011

Hi group. I came across this article on Facebook, written by an IR--He says

Restenosis is a matter of when not if. He says that's not a deterrent, just

something everyone should expect, regardless of stent or balloon. He says CCSVI

can last anywhere from 4 months to 18 months before needing repeating...For me

this has really made me less likely to do it. Anyway, here is the articl:

Read this article by Dr. Hewett - an IR at Pacific Interventionalists in

California - it will help you - RESTENOSIS WILL HAPPEN - Venous Stenting and

CCSVI ~ Dr. Hewett presentation January 29, 2011 (Seattle)

by Venöse Multipl...e Sklerose, CVI & SVI, CCSVI on Tuesday, February 1, 2011 at

1:10pm

" Driving down the side streets will never be as fast as driving down the

highway " ~ Dr. ph Hewett commenting on collateral veins and why we need to

treat CCSVI.

Dr. Hewett wanted to do the session to correct a lot of misinformation that is

circulating about stents. First, he detailed a long history of using stents to

correct circulatory problems, beginning in 1856 with a dentist aptly named " Dr.

Stent. " With angioplasty becoming commonplace after 1964, stenting eventually

became associated with this procedure by 1994. In 2003, drug coated stents for

arteries were developed to prevent restenosis.

Stents were used in many areas of the body, beginning with the liver and trachea

before being used for arterial procedures. Many types of stents are appropriate

for use in veins; in fact, stents are not designed for only one type of vessel,

but are designed in terms of what they can achieve in terms of improving blood

flow.

Surprisingly, Dr. Hewett said there's no proof stents keep veins open longer

than angioplasty alone. This, of course, doesn't refer to situations where

angioplasty failed to work in a particular location, but refers to a comparison

between veins successfully treated with angioplasty versus veins successfully

treated with a stent. Dr. Hewett stressed that ALL VEINS WILL RESTENOSE. It's

not a matter of " if " -- it is a matter of " when. " Restenosis generally occurs

after 4-6 months and usually much later (12-18 months) and is a very gradual

process taking many months before total restenosis happens. He said that if

symptoms return before the 4-6 month period, it is a matter of undertreatment

and not restenosis.

Stents should be 20% wider than the vein in which they are placed. If a stent is

put in properly, it won't move (sometimes called " jumping " ). Stents are not,

contrary to a lot of the buzz out there surrounding CCSVI, strangers to veins --

Dr. Hewett says he has placed over 5000 venous stents over his 15 year career.

For instance, May-Thurner Syndrome has been known for decades and usually

requires a stent. Kidney dialysis patients also need stents in their veins

because angioplasty is not effective for their needs. The main issue is whether

to use a stent in the first place. If it is indicated for a number of reasons,

such as blood flow and patient outcomes, it is best to use it. In terms of

CCSVI, though, stent use is still quite rare.

Some issues people worry about with stents is a stent fracture. This is a very

low incidence occurrence and may not actually lead to a problem for the patient.

Stents may also be too small for their location and need to be fractured

deliberately by widening with angioplasty. To deal with fractures, another,

larger stent needs to be placed inside the smaller one to cover any exposed

edges of the fractured stent. These corrections work quite well with few

complications.

The azygos vein is unique in that there's only one vein providing drainage for

this area of the body. Many other veins, such as the jugular veins, have

backups; the azygos does not. This vein can get squished between the heart and

the spine. A branch of the vein, the hemiazygos, can get squished by the aorta.

Because there are no alternative veins to supply drainage, these areas often

need stenting because angioplasty alone will not keep blood flowing.

Presence of a stenosis is sometimes difficult to detect and isn't strictly a

visual determination. A pressure gradient of 3-5 mm of mercury before and after

the blockage warrants treatment. This is a much lower pressure gradient than was

traditionally thought to cause problems. Dr. Hewett describes the situation

where a patient has symptoms indicating a problem with the azygos (walking,

bowel, bladder), but no obvious stenoses. He recommends using balloons to assess

the vein three dimensionally because a two dimensional assessment (dye) may not

be sufficient to detect a stenosis. He feels the azygos is a crucial area for MS

patients to have completely assessed.

However, blockages do not always need to be treated. It is necessary to look at

the big picture and always try angioplasty first if symptoms are present.

Sometimes leaving a vein stenosis intact is preferable because angioplasty would

not significantly affect clinical outcomes for the patient and would

unnecessarily damage the vein. Jugular veins are rarely, rarely stented. Dr.

Hewett is now using fewer stents in this area than when he first started

treating CCSVI a year ago.

In the question and answer period, Dr. Hewett stressed that we should get the

fluoro time from our treatment doctors because of the potential radiation

exposure. This time indicates how long we were exposed to the dye used during

the procedure to assess blood flow. In the United States and Canada, it is the

law to keep this time very short. Dr. Code mentioned one patient who had CCSVI

treatment and had two hours of radiation exposure during the procedure, leading

to all of her hair falling out. Dr. Hewett said this couldn't happen in the US

or Canada because of the regulations. He didn't think patients need to be overly

concerned about repeated angioplasties (meaning repeated exposure to this dye),

mentioning that we probably are exposed to more radiation coming out of building

materials used in our homes; however, it is important to keep this information

in our medical records.

After treatment, aggressive anti-inflammatory protocols (diet, drugs) will

minimize scarring and prolong treatment effects. But remember, RESTENOSIS WILL

HAPPEN. (I find it curious restenosis is often cited as a reason a) not to have

CCSVI treatment in the frst place, and evidence of a failed treatment. It is

neither -- it is expected with CCSVI angioplasties as it is with all other

angioplasties.)

Finally, Dr. Hewett closed with stressing the need for a lifelong commitment to

monitor and treat restenosis because it will happen in every location that has

been angioplastied. He said there's no difficulty if we have to have

angioplasty, for instance, every three years throughout our lives to make sure

our veins stay open. He left it open that a more permanent solution may be found

eventually.

April 10, 2011

Thank you Alan for your post, with an appointment for CCSVI scheduled for May

19th this gives me more information going into the procedure. Thank you. Did

you find this under the doctorâ€™s name or the CCSVI profile page?

Edie

From: Alan

Sent: Wednesday, April 06, 2011 12:16 PM

To: mscured

Subject: Restenosis is a matter of when not if--According to this

expert