Shadowing Practice: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Learn English Speaking with Video

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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.

Take.

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אוצר מילים והערות הגייה לשיעור הזה

שיעור הדיבור הזה ברמה C2 מבוסס על הסרטון “12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke”. המילים שחוזרות הכי הרבה: catheter, stent, micro, wire, retriever. בסרטון הזה יש 99 משפטים ו-1275 מילים לתרגול Shadowing. הדיבור נמשך 9:24. הדובר שומר על קצב יציב של כ-136 מילים בדקה, קצב נוח לתרגול Shadowing. רק 70% מהמילים נמצאות בין 3,000 המילים הנפוצות ביותר באנגלית, כך שאוצר המילים מאתגר.

אוצר מילים מרכזי בסרטון הזה

10 המילים המתקדמות ביותר בסרטון, עם ההגייה והמשמעות שלהן:

מילה	הגייה	משמעות
catheter שם עצם	/ˈkæθɪtɚ/	צנתר
microwave שם עצם	/ˈmaɪkɹoʊˌweɪv/	מִיקְרוֹגַל
artery שם עצם	/ˈɑɹ.təɹ.i/	עוֹרֶק
balloon שם עצם	/bəˈlun/	בָּלוֹן
injection שם עצם	/ɪnˈd͡ʒɛk.ʃən/	זְרִיקָה
hug פועל	/hʌɡ/	חיבק \ חִבֵּק, חָבַק
connector שם עצם	/kəˈnɛktɚ/	מחבר
culprit שם עצם	/ˈkʌlpɹɪt/	אשם
hornet שם עצם	/ˈhɔɹ.nɪt/	צרעה, דַּבּוּר
sheath שם עצם	/ʃiθ/	נרתיק

Phrasal verbs שתשמעו

מילה	הגייה	משמעות
come out פועל	/ˌkʌm ˈaʊt/	יָצָא

הגייה ששווה לשים לב אליה

הדובר משתמש ב-4 קיצורים וצורות מקוצרות, כמו I'm, can't, we've. אמרו אותם בצורה הקצרה, כפי שאתם שומעים אותם.

הצלילים של “th”: catheter /ˈkæθɪtɚ/, sheath /ʃiθ/
הצלילים של “sh” ו-“zh”: aspiration /ˌæspəˈɹeɪʃən/, occlusion /əˈkluː.ʒən/, injection /ɪnˈd͡ʒɛk.ʃən/, respiration /ɹɛspɪˈɹeɪʃən/, sheath /ʃiθ/
מילים ארוכות — שימו לב להטעמה: aspiration /ˌæspəˈɹeɪʃən/, cardiologist /ˌkɑɹdiˈɑlədʒɪst/, hemiplegia /ˌhem.ɪˈpli.dʒə/, pictorial /pɪkˈtɔɹi.əl/, respiration /ɹɛspɪˈɹeɪʃən/

צלילים שדוברי עברית מתקשים בהם:

/w/ — שפתיים מעוגלות, לא /v/: microwave /ˈmaɪkɹoʊˌweɪv/, whereby /wɛə(ɹ)ˈbaɪ/
/æ/ — פתוח יותר מה-“אֶ” העברית, לא כמו “a” ב-“cup”: catheter /ˈkæθɪtɚ/, aspiration /ˌæspəˈɹeɪʃən/, basilar /ˈbæz.əl.ɚ/, entangle /ɪnˈtæŋ.ɡəl/, tract /tɹækt/
/r/ — הלשון לא נוגעת בשום מקום, לא ה-“ר” הגרונית: microwave /ˈmaɪkɹoʊˌweɪv/, retriever /ɹiˈtɹivəɹ/, aspiration /ˌæspəˈɹeɪʃən/, artery /ˈɑɹ.təɹ.i/, carotid /kəˈɹɑt.ɪd/

איך לתרגל עם הסרטון הזה

הקשיבו לכל הסרטון פעם אחת בלי לדבר, ורשמו את המילים שאתם לא מכירים.
תרגלו Shadowing משפט אחר משפט במהירות רגילה, וחזרו על כל משפט עד שהקצב שלכם תואם את הדובר.
הקליטו את עצמכם והשוו למקור, תוך תשומת לב למילים כמו catheter, microwave, artery.

מהי טכניקת השאדואינג?

שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.

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Shadowing Practice: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Learn English Speaking with Video

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אוצר מילים והערות הגייה לשיעור הזה

אוצר מילים מרכזי בסרטון הזה

Phrasal verbs שתשמעו

הגייה ששווה לשים לב אליה

איך לתרגל עם הסרטון הזה

מהי טכניקת השאדואינג?