The recent article in the New York Times on CCSVI and the Liberation Procedure From M.S. Patients, Outcry for Unproved Treatment - NYTimes.com brings up a critical issue for those fortunate enough to have received the procedure. Restenosis is a significant issue and requires a full scale effort to prevent. I do believe it is preventable but first it needs to be addressed and preventative strategies put in place. Some of these strategies are the responsibility of the interventional radiologist and the stents he utilizes; some are the medicines utized after the procedure; and some fall on the shoulders of the patients. It is truly an integrative approach which keeps veins open. There is much known about restenosis from the coronary artery disease realm; ever since the invention and widespread use of angioplasty for heart arteries and subsequently stent placements, cardiologists and medical device researchers have been in a "battle" to fight this formidable adversary. This research and understanding is extremely applicable to the "lucky ones" who have been liberated. Maintenance of liberation is a very high priority mission!
Restenosis is usually broken down into categories based on the amount of time since the procedure. A very good, technical discussion of restenosis in relation to heart arteries can be found at the following link from Wikipedia: Restenosis - Wikipedia, the free encyclopedia. Thus, there are two basic scenarios: first, in early restenosis, the body has an acute reaction resulting from the trauma to the inside of blood vessel walls occuring during the procedure resulting in the body attempting to heal this trauma and "overhealing" the area causing clot to form. Clot inside stents or newly opened vessels with balloon angioplasty is bad; closure of an opened vessel is the result. This form of restenosis is prevented with blood thinning agents used during the procedure and then taken after the procedure for a period of time(recommendations vary from 3-12 months after the procedure). The usual standard for medical therapy after the procedure is aspirin and plavix. These medicines inhibit platelets(the blood clotting cells) from adhering and forming a clot. They tend to increase a person's bleeding time as a consequence of their action but they are very good at what they do (preventing clotting). I bruise and bleed after minor traumas quite easily since starting these medicines but I have come to realize this is really good for me and the openness of my jugular veins.
The second type of restenosis is termed late restenosis. This usually occurs 3-6 months after the procedure. It results from a completely different mechanism than early restenosis. The scientific term for this form is "neointimal hyperplasia". This is a process that usually occurs inside a stent and results in proliferation of cells that line the inside of the blood vessels. These cells have microtubules which provide the structure and strength of the healing tissue. While we usually want solid structure and strength in our tissues, we do NOT want this tissue to become too thick blocking the blood vessel canal and leading to re-blockage. Thankfully, the developers of stents have been working on this issue for over a decade and have come up with really good strategies to inhibit this "thickening". The newer "drug-eluting" stents have significantly decreased the incidence of restenosis at this stage. Stents now usually have a drug which blocks the cell replication of the microtubles without injuring them thereby preventing the proliferation and "hyperplasia"(thickening). These drugs are chemotherapy agents used to fight cancer when used intravenously but they can be used in very low concentrations(100-1000 lower blood levels) delivered locally through the stent thus preventing the side effects that occur with systemic chemotherapy. With these technical advances, the incidence of restenosis at this stage has decreased from 30-40%(with angioplasty alone) to less than 5% with drug-eluting stents. Multiple Sclerosis patients are extremely fortunate to be able to benefit from the incredible research and technology which has evolved from the coronary artery angioplasty and stent revolution which has occured in the past 2 decades.
Lastly, there is an entity known as very late restenosis. This occurs about 1 year or more after procedures and may be a function of stopping anti-platelet therapy or may involve re-blockage from the same mechanisms that initially caused the blockages. Less is known about this entity and therapy may be more based on healthy lifestyle(see below) than medical, technological solutions.
Now, I have said a lot so far and may have overwhelmed some. That is NOT at all my intention.
I have given the "medical" side of the issue thus far. That is important to understand but is mostly up to our "liberators". There is a whole other side to the equation that we as patients and recipients of the Liberation Procedure can partake in to actively engage in our healing and liberation. This side is much less talked about in the medical literature but is every bit as important in my opinion and can make a world of difference in our healing outcomes. It involves the core of healthy living for MS patients, coronary artery patients and for truly all people. It addresses a core aspect of health: maintaining flow. Chinese medicine has focused on the flow of chi for five thousand years and now we MUST learn these lessons so that we can thrive, keep our veins and arteries open and heal. It is all very possible and not just up to the proceduralists and researchers who have developed this incredible technology. They give us a new beginning and we then are free to go forth and prosper. My next blog will go into depth on the maintenance of flow and the incredible power we have to get ourselves well and keep ourselves well.
But before that, I want to make it very clear: restenosis is preventable! Medical technology has led to dramatically decreasing restenosis rates in coronary artery disease and good self care can improve the prognosis even further. Aligning with the healing powers available to us can keep our vessels open. Believing in this possibility is the first step in getting a good result.
Restenosis is usually broken down into categories based on the amount of time since the procedure. A very good, technical discussion of restenosis in relation to heart arteries can be found at the following link from Wikipedia: Restenosis - Wikipedia, the free encyclopedia. Thus, there are two basic scenarios: first, in early restenosis, the body has an acute reaction resulting from the trauma to the inside of blood vessel walls occuring during the procedure resulting in the body attempting to heal this trauma and "overhealing" the area causing clot to form. Clot inside stents or newly opened vessels with balloon angioplasty is bad; closure of an opened vessel is the result. This form of restenosis is prevented with blood thinning agents used during the procedure and then taken after the procedure for a period of time(recommendations vary from 3-12 months after the procedure). The usual standard for medical therapy after the procedure is aspirin and plavix. These medicines inhibit platelets(the blood clotting cells) from adhering and forming a clot. They tend to increase a person's bleeding time as a consequence of their action but they are very good at what they do (preventing clotting). I bruise and bleed after minor traumas quite easily since starting these medicines but I have come to realize this is really good for me and the openness of my jugular veins.
The second type of restenosis is termed late restenosis. This usually occurs 3-6 months after the procedure. It results from a completely different mechanism than early restenosis. The scientific term for this form is "neointimal hyperplasia". This is a process that usually occurs inside a stent and results in proliferation of cells that line the inside of the blood vessels. These cells have microtubules which provide the structure and strength of the healing tissue. While we usually want solid structure and strength in our tissues, we do NOT want this tissue to become too thick blocking the blood vessel canal and leading to re-blockage. Thankfully, the developers of stents have been working on this issue for over a decade and have come up with really good strategies to inhibit this "thickening". The newer "drug-eluting" stents have significantly decreased the incidence of restenosis at this stage. Stents now usually have a drug which blocks the cell replication of the microtubles without injuring them thereby preventing the proliferation and "hyperplasia"(thickening). These drugs are chemotherapy agents used to fight cancer when used intravenously but they can be used in very low concentrations(100-1000 lower blood levels) delivered locally through the stent thus preventing the side effects that occur with systemic chemotherapy. With these technical advances, the incidence of restenosis at this stage has decreased from 30-40%(with angioplasty alone) to less than 5% with drug-eluting stents. Multiple Sclerosis patients are extremely fortunate to be able to benefit from the incredible research and technology which has evolved from the coronary artery angioplasty and stent revolution which has occured in the past 2 decades.
Lastly, there is an entity known as very late restenosis. This occurs about 1 year or more after procedures and may be a function of stopping anti-platelet therapy or may involve re-blockage from the same mechanisms that initially caused the blockages. Less is known about this entity and therapy may be more based on healthy lifestyle(see below) than medical, technological solutions.
Now, I have said a lot so far and may have overwhelmed some. That is NOT at all my intention.
I have given the "medical" side of the issue thus far. That is important to understand but is mostly up to our "liberators". There is a whole other side to the equation that we as patients and recipients of the Liberation Procedure can partake in to actively engage in our healing and liberation. This side is much less talked about in the medical literature but is every bit as important in my opinion and can make a world of difference in our healing outcomes. It involves the core of healthy living for MS patients, coronary artery patients and for truly all people. It addresses a core aspect of health: maintaining flow. Chinese medicine has focused on the flow of chi for five thousand years and now we MUST learn these lessons so that we can thrive, keep our veins and arteries open and heal. It is all very possible and not just up to the proceduralists and researchers who have developed this incredible technology. They give us a new beginning and we then are free to go forth and prosper. My next blog will go into depth on the maintenance of flow and the incredible power we have to get ourselves well and keep ourselves well.
But before that, I want to make it very clear: restenosis is preventable! Medical technology has led to dramatically decreasing restenosis rates in coronary artery disease and good self care can improve the prognosis even further. Aligning with the healing powers available to us can keep our vessels open. Believing in this possibility is the first step in getting a good result.
Comments
Thanks,Gina
I do know that veins are not arteries, so we have to be careful when trying to apply known arterial truths to veins. We are dealing with two very different beasts, I'm afraid.
Glad you are still feeling so well! Hope my latest treatment lasts much longer than the first!
Nicole