Pratique du Shadowing: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Apprendre l'anglais à l'oral avec la vidéo

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I'm Dr. Asim Javed.

I'm an international cardiologist working at Rawalpindi Institute of Cardiology in Pakistan.

This is a series of talks to facilitate learning process for performing mechanical thrombectomies in acute ischemic stroke.

Let's now discuss a bailout parallel strength strategy.

This is a 58 year old gentleman with left ICR terminus

occlusion two solumbra attempts had already failed having ruled out icad

and considering this to be an embolic thing now is a good time to do the parallel stent technique in

which in this case we wired acf first

and then we took a tip injection in aca a1 segment to confirm

that we are in the right place then we wire mcm1 confirm the wire position

and mcm1 and place our micro catheter there so now

that both the micro catheters are in place we deployed the first stent retriever in mca

and then removed its micro catheter then we deployed the second micro catheter in aca

and removed its micro catheter as well so we removed both the micro catheters

and now we've got both stent retrievers deployed

and we have the bare wires coming out and we are holding both the bare wires.

And then the next thing we did was we removed both we removed both stent retrievers together and pulled out everything.

But unfortunately we still could not establish flow.

So what we could have done different was to use double

-save technique whereby after deploying both stent retrievers the two ray bars are removed the micro catheters

and then the aspiration catheter slides over the wires of the two stent retrievers

and then both stents are pulled out simultaneously while doing suction through the aspiration catheter as well.

So that gives you maximum success

and in fact you can even have a balloon tip guide at that point and the balloon is also inflated.

So that will increase maximum chances of success and reduce the chances of distal embolization.

So this is exactly what is shown in this picture in a systematic way

that first thing you do is you deploy the two micro

catheters in the two arteries where you want them you never deploy one stent first

and then try to wire the second artery your wire is not going to cross through the stent retriever

and even if it crosses through the second stent retriever will entangle into the first stent retriever

so you always wire first artery then you place your micro catheter in

that artery then you remove the same wire

and you do not deploy the stent at this point in time you take this wire

and place it into the second artery

and then you park your micro catheter in the second artery

once both micro catheters are in place then you can bring

in your stent retriever in any of these micro catheters deploy

the first stent retriever then deploy the second stent retriever then remove both the micro catheters

and the bare wires

that are coming out of the guide catheter now you need to take them out of your wire connector simultaneously

and then on top of these two wires you bring in your respiration catheter

which could be SOFIA or REACT

and then you take it right all the way to the clot

and once it starts it once it hugs the clot that's the time you start your aspiration

so now you are doing sort of solumbra with two stent retrievers

and one aspiration catheter so this is the double safe technique and

if you have a balloon tip guide you also deploy the

inflate the balloon of the balloon tip guide at this point

and then you pull out everything and you get the maximum chances of success

so this is the parallel stent technique Why you need to remove the two micro catheters

and you can't take aspiration catheter from the beginning because the two micro catheters cannot go simultaneously through the aspiration catheter.

So we have to most likely deploy both the stent retrievers

and micro catheters through the guide catheter and not through the aspiration catheter

so this is a 45 year old lady with four hours

history of left -sided hemiplegia patient had left ICA critical disease

which was non -culprit but was cross -filling right ACA right common carotid artery was totally occluded

so basically this was a case of acute on chronic total

occlusion of right common carotid artery six French 90 centimeter guide sheath six French aspiration catheter and Raybar micro catheter was taken.

Traxxas wire could not cross.

Pilot 200 and Gaia CTO wires could not cross the occlusion as well.

Hornet 14 wire was able to cross the occlusion with the help of Caraval micro catheter.

Check injection through Caraval micro catheter tip was done to confirm true lumen.

Sophia plus 6 French failed to cross the proximal occlusion site.

So we plan to do POBA in presence of distal protection filter.

7 mm spider FX filter was deployed in right internal kerotid artery

and then right ICA osteoballooning was done with 4 .5 by 15 mm NC tract balloon.

Post ballooning there was no flow in the kerotid.

6 French aspiration catheter for aspiration was used for aspiration up to the spider effects.

So we thought there was no reflow because of the spider effects blockage.

But it could not establish flow.

So then trexus wire was brought back into the internal carotid artery and spider effects was removed.

Again aspiration was done with SOFIA plus

and this time flow was established in ICA but ICA terminus occlusion was found to be occluded.

but one minute later the carotid flow also stopped again.

This time we decided to deal with austere ICA first and deployed carotid wall stent 7 by 30 millimeters.

Then we went on to deal with ICA terminus occlusion

and performed Solumbra with SOFIA plus and Solitaire X 4 by 40 millimeters

but after three attempts of Solumbra ICA terminus still remain occluded.

We decided to go with parallel stent technique.

Right ACA could not be wired and was cross -filled from left ACA.

So we placed both wires in superior and inferior deviance of MCA.

Two Raybar microcatheters were placed in both MCA deviance.

Two stent retriever solitaire X 4x40 mm were deployed in ICA terminus starting from proximal segments of M2 deviance.

Both rebars were removed and SOFIA plus was brought in and then the whole assembly was removed as one unit.

right ICA and MCA were re -canalyzed

and right ACA was cross -filled through ACOM right ICA stent was also patent

and this is our neurologist examining the patient two hours later in the ward

and the other side is the bagu, the bagu

and the bagu is the bagu and the bagu is the bagu

and the bagu is the bagu and the bagu is the bagu and the bagu is the bagu

This is the case of basilar reclution One attempt of ADAPT

and two attempts of Sulembra failed to re -canalyze basilar artery

We decided to go with parallel stent technique You can see wire going into left PCA across the distal basilar occlusion.

Ribber was parked in left PCA and then second wire and micro catheter were taken into the right PCA.

Now you can see two stent retrievers 4x40 mm deployed in both PCAs

and SOFIA plus aspiration catheter in place just hugging the clot.

Both stent retrievers and SOFIA were removed as one unit and this is a comparison of pre and post intervention DSA images.

This is again pictorial representation of the parallel stent technique and now this is the patient 48 hours later.

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Vocabulaire et conseils d’expression pour cette leçon

Cette vidéo contient 99 phrases et 1275 mots à répéter en shadowing. La partie parlée dure 9:24. Le locuteur parle à un rythme régulier d’environ 136 mots par minute, confortable pour le shadowing. Seuls 70 % des mots font partie des 3 000 mots les plus courants en anglais, le vocabulaire est donc exigeant.

Vocabulaire clé de cette vidéo

15 mots de la vidéo à retenir, avec leur prononciation et leur sens :

Mot	Prononciation	Sens
wire nom	/ˈwaɪɚ/	fil
microwave nom	/ˈmaɪkɹoʊˌweɪv/	micro-onde
artery nom	/ˈɑɹ.təɹ.i/	artère
technique nom	/tɛkˈniːk/	technique
balloon nom	/bəˈlun/	ballon
parallel adjectif	/ˈpæ.ɹəˌlɛl/	parallèle
spider nom	/ˈspaɪ̯dɚ/	araignée
establish verbe	/ɪˈstæb.lɪʃ/	affermir, instaurer
confirm verbe	/kənˈfɝm/	confirmer
simultaneously adverbe	/ˌsaɪmlˈteɪnɪəsli/	simultanément, en même temps
filter nom	/ˈfɪltɚ/	filtre
segment nom	/ˈsɛɡmɛnt/	segment
hug verbe	/hʌɡ/	étreindre, serrer
acute adjectif	/əˈkjut/	aigu, aiguë
injection nom	/ɪnˈd͡ʒɛk.ʃən/	injection

Les verbes à particule que vous entendrez

Mot	Prononciation	Sens
pull out verbe		se retirer
come out verbe	/ˌkʌm ˈaʊt/	sortir
rule out verbe		barrer, biffer

Prononciation à surveiller

Le locuteur utilise 4 contractions et formes réduites, comme I'm, can't, we've. Prononcez-les sous leur forme courte, telles que vous les entendez.

Les sons « th »: catheter /ˈkæθɪtɚ/, sheath /ʃiθ/
Les sons « sh » et « zh »: establish /ɪˈstæb.lɪʃ/, injection /ɪnˈd͡ʒɛk.ʃən/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, intervention /ɪntɚˈvɛnʃən/, aspiration /ˌæspəˈɹeɪʃən/
Mots longs — placez bien l’accent: simultaneously /ˌsaɪmlˈteɪnɪəsli/, superior /sʊˈpɪɹ.i.ɚ/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, mechanical /məˈkænəkəl/, intervention /ɪntɚˈvɛnʃən/

Comment s’entraîner avec cette vidéo

Écoutez la vidéo en entier une fois sans parler et notez les mots que vous ne connaissez pas.
Répétez phrase par phrase à vitesse normale, en reprenant chacune jusqu’à ce que votre rythme corresponde à celui du locuteur.
Enregistrez-vous et comparez avec l’original, en faisant attention à des mots comme wire, microwave, artery.

Qu'est-ce que la technique du Shadowing ?

Le Shadowing est une technique d'apprentissage des langues fondée sur la science, développée à l'origine pour la formation des interprètes professionnels. Le principe est simple mais puissant : vous écoutez de l'anglais natif et le répétez immédiatement à voix haute — comme une ombre suivant le locuteur avec un décalage de 1 à 2 secondes. Les recherches montrent une amélioration significative de la précision de la prononciation, de l'intonation, du rythme, des liaisons, de la compréhension orale et de la fluidité.

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Pratique du Shadowing: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Apprendre l'anglais à l'oral avec la vidéo

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Vocabulaire et conseils d’expression pour cette leçon

Vocabulaire clé de cette vidéo

Les verbes à particule que vous entendrez

Prononciation à surveiller

Comment s’entraîner avec cette vidéo

Qu'est-ce que la technique du Shadowing ?