Restenosis as many of you know is one of several words/acronyms associated with JVH which I think is suboptimal. Valvular Recoil is a more accurate way of describing what causes relapse after treatment in most patients. Annular valve type is present in a minority of patients and in this subset restenosis would be appropriate since treatment is dilation of the valve annulus.

Relapse occurs when jugular flow returns to pre-treatment levels or worse. We have little control over this process beyond the procedure. Thrombosis mediated relapse is the term used to describe relapse resulting from the jugular clotting after the procedure. Most of these occur within the first few days after treatment. We are however seeing clots develop several weeks after treatment and are moving to a longer period of anticoagulation. This is the type of relapse we have the ability to modulate with use of anticoagulation. This does add increased bleeding risk. The balance of risk versus benefit is always a challenge. With more research will will have a better handle on the most efficacious and safe treatment algorithms.

Our experience is however clear. Anti-aggregation medications such as plavix and aspirin are insufficient in preventing clinically relevant jugular thrombosis following JVH therapy. Furthermore, in our opinion anticoagulation therapy should be extended beyond a few weeks to prevent late thrombosis.

http://www.facebook.com/notes/mike-arata/relapse-thrombosis-mediated/171909539553461