Experience with stent after decompression?

[Octoberkurt]

Though I’m well aware that the placement of a stent many months after decompression may not be advised by some surgeons, I am curious to learn from those who have actually had a stent put in place to further open an IJV. I’ve had both styloids removed, but imaging still shows marked narrowing on both sides, months after surgeries.

[Isaiah_40_31]

@Octoberkurt - I’m sorry you still have compressed IJVs!

Before considering a stent, you should get another opinion from one or two of the other doctors we know of who do IJV decompressions. Each doctor has a different approach to that surgery & it’s possible one of them would see something else that could be done to provide more complete decompression vs getting a stent or stents.

Dr. Costantino & Dr. Liu both do telehealth consults & would be worth contacting for another opinion.

Dr. James K. Liu, 200 S. Orange Ave, Ste. 265, Livingston NJ, ph # - 973-577-2888 Dr. James K. Liu | Top Neurosurgeon in Livingston, NJ OR https://skullbasemd.com

Dr Peter Costantino, 4 Westchester Park Dr, 4th floor, White Plains, [(914) 517-8056](tel:(914) 517-8056)
http://www.nyhni.org/find-a-physician/Peter-D-Costantino-MD,FACS.
Does do online or phone consults. Email Shantel for an appointment - SMorrison@iss.org
or Brain & Spine Surgeons of New York - Contact Us - Appointments & Questions

Dr. Hepworth & Dr. Cognetti would also be good for a second opinion but they’re both booked well into next year.

[Octoberkurt]

Yes, thank you, there is always the second opinion route. However, to be very clear, my doctors, both Dr Mehta and Dr Nakaji are not suggesting stents, only that a long conversation would have to take place regarding same. I’ll be conferring with Dr Mehta next week, in person, about this. Not saying I’m pushing for stents, but I’m still very curious as to seeing input here from anyone who has actually had stents placed in one or both IJVs. I’ll be seventy years old in a couple of weeks and it would be VERY nice to, for once in my lifetime, know what unrestricted blood flow through the brain feels like. So…anyone with stent experience?

[anon30378544]

@anon30378544

Narrow jugular openings are also found in 10-30% , and compression is higher than C1 between the muscle and the root of the styloid process . And C1 resection is partially successful at decompression (if the muscle is cut off and it no longer interferes with the vein). As a result, C1 resection in the case of a very low jugular opening(foreman) has almost no chance of success (with a narrow jugular opening/foreman, the chances of successful vein expansion are negligible. It is necessary to solve the problem with the jugular opening/foreman or expand the emissary veins (vertebral veins)).

and

@anon30378544

2. Resection of C1 on the left side (will practically yield no results) will have virtually no effect on venous outflow on the left (the left IJV will not dilate, since the main problem with the thin left IJV is the jugular foramen). There is a very small chance of success in expanding the left internal jugular vein (IJV) in his case with C1 resection.

and

@anon30378544

I will repeat once again about hypoplasia (thin vessels) of blood vessels (hypoplasia of vertebral arteries, hypoplasia of transverse venous sinuses, and so on. Based on the laws of hydrodynamics and biomechanics of vessels. When there is some compression of the vessel, the blood flow decreases and over time the vessel becomes thinner.

For example, hypoplasmic transverse venous sinus. One of the main causes of hypoplasia is a narrow jugular opening (foramen) in the skull. And installing a stent in the transverse venous sinus will only give a slight improvement in blood flow. Because the jugular foramen (local resistance) remains unchanged, which affects the blood flow. To solve the problem completely, you need to enlarge the ugular foramen. (a narrow jugular foramen may be congenital (from birth), due to injuries to the skull or diseases of the mastoid process ). After solving the problem with the jugular foramen, you can perform a balonoplasty without a stent, or wait for the transverse venous sinus to expand on its own over time when the jugular foramen is large.

It’s the same with the vertebral arteries. The main cause of their hypoplasia (thinning) is local stenosis (partial). These are usually strong bends at the mouth of the vertebral artery, or compression by some structures.

and

@anon30378544

Please, who will communicate with the doctors, bring this information.

1. That is, your IJV may be thin not due to the surrounding structures in the C1 region. Your IJV may be thin due to a narrow jugular foramen or compression above C1 — between the muscle and the root of the styloid process (between the rectus capitis lateralis and the remainder-the root of the styloid process).

2. Based on the medical articles by Dr. Higgins and Dr. Axon, as well as Paolo Zamboni’s vascular surgery, and Also, the opinion of Dr. Peter Nakaji, who has been working on vein decompression since 2011 (and who, together with his mentor Michael Lawton, began studying this)-------Cases of stent deformation do occur, and they are not entirely rare. That is, after stent placement, some patients experience recurrence of narrowing of the IJV and the stent, the stent becomes deformed, and, less commonly, stent and IJV thrombosis may occur.

@anon30378544

you need to study CT scans in more detail

@anon30378544

Please, who will communicate with the doctors, bring this information.

[anon30378544]

read above

[Jules]

I’m sorry that there’s still narrowing of your IJVs… I hope that you get some replies from members, but this isn’t something that many have tried that I recall, partly because of the risks I guess.

[Octoberkurt]

Thank you for this information. All has been read and is further indication that each medical case is quite complicated and warrants much testing to fully determine root cause(s).