Shadowing Practice: SVINutes: Intracranial Atherosclerotic Disease: Key Considerations for Stenting - Learn English Speaking with Video

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Hello, I am Amir Hassan, and on Zvinitz today we will be talking about intracranial atherosclerotic disease, key considerations for stenting.
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ICAT is a significant cause of ischemic stroke, responsible for 10% of ischemic strokes in the US and up to 50% in Asia.
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In South Texas, we have a 20-30% incidence.
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The disease process, you have a lot of plaque buildup, which leads to stenosis, increasing stroke risk.
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The key stroke mechanisms include hemodynamic compromise, artery embolism, in-situ thrombosis, and perforator strokes.
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Current treatment approaches include medical management with anticoagulants, antiplatelets, and or statin therapy.
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Interventions that include stenting and angioplasty.
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On cases with hemodynamic compromise, stenting has significant superiority over medical therapy.
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In a patient with a basilar stenosis, as you see here on the CT correlating CT perfusion, would benefit this patient much more than medical therapy.
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Versus a perforator stroke alone, as you can see here, this patient would do much better with medical therapy than intracranial stenting.
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Quick overview of the Sampras trial.
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There was a significant risk of instant stenosis.
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There was a significant risk of ischemic strokes
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and what you had was the medical management arm doing significantly better than the intervention arm
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and the trial was prematurely terminated then fast forward several years
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and we have the weave trial
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and the weave trial results were published in stroke in april 2019
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and the main findings were
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if you stuck to the on-label primary analysis findings you had a 2.6 percent event rate of stroke
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or death within 72 hours versus
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if you were off-label those patients were collected in a registry
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and they had up to 23.9 percent risk of stroke or death within 72 hours.
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One of the lessons learned were adjacent perforators.
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You had to undersize the balloon in those lesions and your goal was 60 to 80 percent true lumen diameter.
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Also experience mattered.
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In studies where the enrollment sites had the experience of treating three cases or on on average 10 cases like in Sampras, you had a much higher event rate.
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Whereas in Weave, the average interventionist had placed 37 wingspan stents prior to enrollment.
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Those who had high experience, greater than 50 wingspan stents prior to their first patient enrollment in Weave had a 0% event rate.
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We have several studies that looked at our initial experience with the Resolute Onyx stent, balloon-mounted stent that is drug-coded, and then we looked at 30-day outcomes,
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comparing them to the Sampras medical arm patients with propensity score matching, and we had a multi-center study that included other balloon-mounted stents.
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And what we found was that most of these patients did significantly better if you were on label, meaning you had to treat the patient and wait for seven days,
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maximize medical management with dual anti-plitotherapy and statin therapy, and And we also found significant decreased restenosis rates,
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long-term restenosis, compared to the Wingspan study.
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And here are the publications so you can look at them yourselves.
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The main points here are your tips and your setup for support based on our experience.
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And a key point here is patient selection.
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Patients with severe tortuosity, type 3 arches, an M for a carotid artery,
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common carotid, those cases probably be much more aggressive with your medical therapy before approaching stenting.
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In patients that you do select for stenting, we are very aggressive with P2Y12 testing on all patients.
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If that P2Y12 number is greater than 200, switch the patients to Berlinta 90mg BID.
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My partner does use 60mg BID and we have not found a significant difference between my patients and his patients.
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We always use a bolt ballast or a BMX guide catheter.
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We find that's much more supportive.
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If treating anterior circulation, you will have a lot of difficulty with the radial approach, so we primarily prefer femoral access.
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If you're treating lesions proximal to the periclinoid segment of the carotid, Navian 058-115 is the most supportive DAC.
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If you're treating an MCA lesion, it doesn't cross the periclinoid ophthalmic segments, so a Cat5 or Sophia EX 115 cm is the preferred distal axis catheter.
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We always use Zoom 14 support wire, that is our preferred O14 wire, Synchro 2 support if you don't have the Zoom 14,
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or you can use the Aristotle 14 support wire.
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Regular Synchro 2 and Traxxas just don't have enough support.
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We highly recommend the Resolute Onyx 2x8 mm device because it can comfortably increase in size to about 3.25 with post-dilatation.
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And for all our MCA M1 lesions and our mid-bazilar lesions,
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your perforator-rich teratoids, I don't care if your MCA or your basilar already measures 3-3.5mm, we always use our Resolute Onyx 2x8.
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Thank you very much and have a great day.

Understanding Medical Dialogue: A Real-Life Scenario

The video features a detailed discussion between a medical expert and an audience about intracranial atherosclerotic disease and stenting. This scenario reflects real-world professional communication, where clarity, precision, and technical vocabulary are critical. Whether you’re a healthcare student or an English learner aiming to follow complex discussions, this dialogue offers a chance to practice understanding specialized language in context.

Useful Chunks & Collocations to Master

  • "Key considerations for": Used to highlight important factors in decision-making (e.g., "key considerations for stenting").
  • "Hemodynamic compromise": A technical phrase describing reduced blood flow, common in medical contexts.
  • "Prematurely terminated": Refers to ending a process early, as in "the trial was prematurely terminated."
  • "Propensity score matching": A statistical method, useful for understanding research discussions.
  • "On-label" vs. "off-label": Terms describing approved vs. unapproved uses of treatments (e.g., "on-label primary analysis findings").

Your Shadowing Challenge: Improve Clarity & Pronunciation

Shadowing is a powerful technique to boost your English speaking and listening skills. Here’s how to practice with this video: 1. Play a 10-second clip of the expert speaking. 2. Pause and repeat the clip aloud, mimicking the rhythm, stress, and intonation. Focus on tricky phrases like "intracranial atherosclerotic disease"—break them into syllables if needed. 3. Use a shadowing app to record yourself and compare it to the original. Notice differences in pronunciation, especially of technical terms. 4. Repeat with longer clips as you get comfortable. This exercise helps train your mouth to form complex sounds and improves your ability to follow fast, professional speech. Remember, consistency is key—even 5 minutes daily with the shadowing technique can make a big difference in your English pronunciation and fluency.

¿Qué es la Técnica de Shadowing?

Shadowing es una técnica de aprendizaje de idiomas respaldada por la ciencia, desarrollada originalmente para la formación de intérpretes profesionales y popularizada por el políglota Dr. Alexander Arguelles. El método es simple pero poderoso: escuchas audio en inglés nativo y lo repites en voz alta de inmediato, como una sombra que sigue al hablante con solo 1-2 segundos de retraso. A diferencia de la escucha pasiva o los ejercicios de gramática, el shadowing obliga a tu cerebro y músculos de la boca a procesar y reproducir simultáneamente patrones de habla reales. Las investigaciones muestran que mejora significativamente la precisión de la pronunciación, la entonación, el ritmo, el habla conectada, la comprensión auditiva y la fluidez al hablar, convirtiéndola en una de las metodologías más efectivas para la preparación del IELTS Speaking y la comunicación en inglés en el mundo real.