No one would be denied treatment in Canada for a real jugular vein thrombosis if it were causing any specific symptoms such as pain or swelling in the neck. What I gather from the news report is that the only indication for IV thrombolysis was worsening of his MS symptoms which were ASSUMED to be due to a clot in the stent. If one has spent $30,000 on a treatment that one is convinced must be a cure, one is reluctant to accept that it doesn’t work and that relapse must be due to restenosis requiring more “liberation”. Inserting stents into normal thin-walled veins is hazardous. If the vein were torn it would be very hard to repair. Marcial Fallas, the Costa Rican doctor now claims he didn’t want to use a stent. So why did he? Is there the slightest evidence that a stent would have given Mostic “his life back?” How much extra did Fallas charge for inserting a stent? Is this professional behaviour?
Mostic obviously bled to death internally. Without an autopsy one can never know from which vessel. My guess would be that the stent tore the IJV or the subclavian vein and that he bled into his chest, possibly when clot that might have been blocking the tear was dissolved with thrombolysis.
I predicted such tragedies a year ago when CTV announced this “breakthrough” in MS treatment. Those advocating unrestricted “liberation” on demand now have blood on their hands.
Globe and Mail Update
Patient had returned to Canada, but went back to Costa Rica after blood clot developed
A Canadian man with multiple sclerosis who travelled to Costa Rica to undergo a controversial procedure in June died from complications during follow-up surgery, his doctor said Thursday.
Mahir Mostic, a 35-year-old resident of Niagara Region, went to Clinica Biblica in San Jose last June to be given “liberation therapy,” a procedure in which neck veins are opened up, in hopes of improving blood flow from the brain.
The treatment is based on an unproven hypothesis advanced by Italian doctor Paolo Zamboni that MS is caused by poor blood circulation from the central nervous system, leading to buildups of iron. The procedure is not performed in Canada.
Mr. Mostic’s Costa Rican doctor, Marcial Fallas, said he tried unsuccessfully using balloon angioplasty to open up his patient’s vein, before resorting to inserting a stent, a riskier procedure.
“We are not okay with the idea of a stent,” Dr. Fallas told the Globe and Mail. “But he was desperate, he wanted his life back.”
Mr. Mostic, who had been diagnosed with MS three years ago and had difficulty walking, thought it over and opted for the stent, Dr. Fallas said.
At first, Mr. Mostic showed improvement, but his MS symptoms eventually returned. An ultrasound showed his stent was 80 per cent blocked, Dr. Fallas said.
The doctor said Mr. Mostic returned to the clinic in October, and he was injected with medication in a bid to dissolve the clot. The day after the procedure, his blood pressure began to drop and Dr. Fallas suspects he suffered internal bleeding. Doctors tried to find the source of the bleeding, but to no avail. For religious reasons, his family requested that his body not be autopsied, Dr. Fallas said.
Mr. Mostic’s family declined to comment.
Dr. Zamboni’s hypothesis – called chronic cerebro-spinal venous insufficiency, or CCSVI – is highly contentious. While the medical community generally regards MS as an auto-immune disease, many sufferers have undergone the procedure, crossing borders to do so.
Some have reported blood clots similar to those Mr. Mostic suffered, but have had trouble getting follow-up care in Canada, said Diana Gordon, a Barrie woman who was given the treatment at a clinic in the United States in June.
“When [Mr. Mostic] got back, he should have been allowed surgery after-care, it should have been no problem,” she said. “People don’t have the funds to travel to other countries.”
Researchers in Canada and the United States are studying CCSVI, while Saskatchewan has offered to fund a clinical trial to test the effectiveness of the vein-opening procedure.