Pratique du Shadowing: Carotid Artery Stenting - Tips & Tricks - Apprendre l'anglais à l'oral avec la vidéo
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In this video, we will discuss challenges and difficulty we faced during one of our carotid artery stenting case.
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Patient is 58 year male,
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presented with acute onset of mild weakness of left upper and lower limb.
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He has many risk factors responsible for atherosclerosis like hypertension,
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hypercholestremia, diabetes and he is a chronic smoker.
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MRI brain showed abnormal T2 hyperintensity at coronary later displaying diffusion restriction suggestive of acute infarct.
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This location of infarct suggests deep watershed territory infarct between the perforator arteries and superficial cortical arteries.
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Right carotid angiography showed near total occlusion of right internal carotid artery with poor intracranial flow
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and there is retrograde reformation of the ophthalmic artery via middle meningeal artery collaterals.
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This angiographic findings suggest hemodynamic compromise of right cerebral hemisphere.
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So we plan for carotid artery stenting under embolic protection device in this case.
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The procedure could be divided into following steps.
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Carotid access, measurement and choosing the appropriate carotid stent and filter size,
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pre-dilatation, embolic filter device deployment, stent deployment and post-dilatation.
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These are the hardware we used in this case.
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Safe carotid access is the first step of carotid artery stenting procedure.
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Always look for unfavorable arch in CT angiography images.
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We placed 8F short sheet at groin and taken 6F long sheet over diagnostic catheter under fluoroscopy to right common carotid artery.
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By this technique we could avoid the exchange maneuver.
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This is the right common carotid artery injection via long sheet.
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We obtained measurement.
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Based on our measurement we choose 6 to 8 millimeter tapered stent from abort
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and we also use a smaller size of available embossed shield.
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As the stenosis is very tight
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and crossing profile of filter device is larger we plan to pre-dialect the stenosis using the coronary balloon.
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We use 1.4 BMW coronary wire and 2.5 mm size of the coronary balloon to dilate the stenosis.
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There is significant improvement of the lumen after the angioplasty.
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Now we cross the lesion using O.1.4 bare wire of the filter device.
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It has a 3 cm distal radio opaque tip which we kept at C1 vertebral level.
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Now AmboShield filter device is taken over the O14 wire.
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Filter is deployed at C2 vertebral level.
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Filter device should be placed in the straight segment of the carotid artery
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and should be more than 2 cm distal to the distal landing zone of carotid stent.
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Filter has migrated proximally to the level of stenosis during removal of its delivery catheter.
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To understand proximal migration of the filter device,
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we need to know the filter design.
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Ambushil filter device has umbrella like nylon membrane and nitinol frame.
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This nylon membrane has multiple micropores to allow the blood perfusion and to trap the embolic material.
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It has two radiopic markers at the proximal and the distal end.
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AmboShield filter device is a monoreal system pre-loaded on O14 wire.
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AmboShield is not fixed on this wire,
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it is freely movable on this wire and because of this there is a risk of intracranial dislodgement of this filter device.
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To avoid any intracranial migration of AmboShield filter device,
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there is a focal step design on the bare wire distal to the filter.
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This focal step is 019 and which will act as a distal limit of the filter device.
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So when this distal 019 step at the bare wire is in contact with the distal marker of the filter device,
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it might drag filter proximally
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if the bare wire is pulled by mistake during the exchange maneuver and this is exactly what had happened in this case.
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We gently push the filter device upward using the retrieval catheter.
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Now stent delivery catheter was taken over O14 bare wire.
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Distal nose of the stent delivery catheter has further pushed the filter device to the desired location.
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Precise location of stent was confirmed by guide catheter injection.
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was deployed and delivery catheter was removed.
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Check angiography showed residual waste so we performed angioplasty of the residual stenosis using 4.5 mm coronary balloon.
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Only after angioplasty, there was complete occlusion of internal carotid artery.
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The possibilities could be that the filter device might have occluded due to the trapped embolic materials
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or acute distant thrombosis or carotid artery dissection and vasospasm.
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We immediately checked ACT which was within desired level.
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We repeated 1000 units of heparin bolus.
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We gave loading dose of agrastat via guide catheter and started IV infusion.
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We also performed aspiration of the thrombus using coronary aspiration catheter.
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After all these efforts, check angiography showed some restoration of the flow in the internal cuted artery and across the filter.
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So we decided to retrieve the filter device.
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While retrieving the filter device,
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we only partially engaged the portion of the filter device inside the retrieval catheter to prevent escape of any trapped emboli.
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After removing the filter device,
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complete flow is restored in the internal carotid artery and the stent.
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Gross examination of the filter device showed trapped embolic materials.
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So we could conclude
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that the sudden occlusion of the carotid artery after balloon angioplasty
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is most likely due to release of lot of embolic materials
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which were trapped by the filter device and causing the complete flow arrest across the carotid artery.
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Once we remove this filter device the flow is restored.
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Final angiogram showed complete revascularization of the internal carotid artery and good restoration of the intracranial circulation.
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This also imply the importance of use of filter device during carotid artery stenting procedure.
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Vocabulaire et conseils d’expression pour cette leçon
Cette leçon d’expression orale de niveau C2 s’appuie sur la vidéo « Carotid Artery Stenting - Tips & Tricks ». Les mots qui reviennent le plus souvent : filter, device, carotid, artery, catheter. Cette vidéo contient 75 phrases et 907 mots à répéter en shadowing. La partie parlée dure 7:26. Le locuteur parle à un rythme régulier d’environ 122 mots par minute, confortable pour le shadowing. Seuls 63 % des mots font partie des 3 000 mots les plus courants en anglais, le vocabulaire est donc exigeant.
Vocabulaire clé de cette vidéo
Les 15 mots les plus avancés de la vidéo, avec leur prononciation et leur sens :
| Mot | Prononciation | Sens |
|---|---|---|
| carotid nom | /kəˈɹɑt.ɪd/ | carotide |
| artery nom | /ˈɑɹ.təɹ.i/ | artère |
| catheter nom | /ˈkæθɪtɚ/ | cathéter |
| distal adjectif | /ˈdɪs.təl/ | distal |
| stenosis nom | /stəˈnoʊ.sɪs/ | sténose |
| angiography nom | /ˌæn.d͡ʒiˈɑ.ɡɹə.fi/ | angiographie |
| angioplasty nom | /ˈæn.d͡ʒi.əʊ.plæs.ti/ | angioplastie |
| balloon nom | /bəˈlun/ | ballon |
| infarct nom | /ɪnˈfɑɹkt/ | infarctus |
| acute adjectif | /əˈkjut/ | aigu, aiguë |
| measurement nom | /ˈmɛʒ.ə.mənt/ | mesure |
| aspiration nom | /ˌæspəˈɹeɪʃən/ | aspiration |
| dilatation nom | /ˌdaɪleɪˈteɪʃ(ə)n/ | dilatation |
| nylon nom | /ˈnaɪlɑn/ | nylon |
| retrieval nom | /ɹɪˈtɹiːvəl/ | récupération |
Les verbes à particule que vous entendrez
| Mot | Sens |
|---|---|
| take over verbe | reprendre |
Prononciation à surveiller
- Les sons « th »: catheter /ˈkæθɪtɚ/, atherosclerosis /ˌæθɚoʊskləˈɹoʊsəs/, ophthalmic /ɑfˈθæl.mɪk/, thrombosis /θɹɑmˈboʊsɪs/, thrombus /ˈθrɑmbəs/
- Les sons « sh » et « zh »: occlusion /əˈkluː.ʒən/, measurement /ˈmɛʒ.ə.mənt/, aspiration /ˌæspəˈɹeɪʃən/, dilatation /ˌdaɪleɪˈteɪʃ(ə)n/, injection /ɪnˈd͡ʒɛk.ʃən/
- Mots longs — placez bien l’accent: coronary /ˈkɔɹənɛɹi/, angiography /ˌæn.d͡ʒiˈɑ.ɡɹə.fi/, angioplasty /ˈæn.d͡ʒi.əʊ.plæs.ti/, intracranial /ˌɪntɹəˈkɹeɪniəl/, aspiration /ˌæspəˈɹeɪʃən/
Les sons difficiles pour les francophones :
- /h/ — il se souffle, il n’est pas muet: hemodynamic /himoʊdaɪˈnæmɪk/, heparin /ˈhɛp.ə.ɹɪn/, hypertension /ˌhaɪ.pɚˈtɛn.ʃən/, hemisphere /ˈhɛmɪsfɪə/
- /tʃ/ et /dʒ/ — à ne pas adoucir en « ch » et « j »: angiography /ˌæn.d͡ʒiˈɑ.ɡɹə.fi/, angioplasty /ˈæn.d͡ʒi.əʊ.plæs.ti/, residual /ɹɪˈzɪd͡ʒ.u.əl/, injection /ɪnˈd͡ʒɛk.ʃən/, meningeal /ˌmɛn.ənˈd͡ʒi.əl/
- /r/ anglais — langue recourbée, sans frotter la gorge: carotid /kəˈɹɑt.ɪd/, artery /ˈɑɹ.təɹ.i/, coronary /ˈkɔɹənɛɹi/, angiography /ˌæn.d͡ʒiˈɑ.ɡɹə.fi/, intracranial /ˌɪntɹəˈkɹeɪniəl/
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 carotid, artery, catheter.
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.