Pratica di Shadowing: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Impara a parlare inglese con i video

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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Vocabolario e note di pronuncia per questa lezione

Questo video contiene 99 frasi e 1275 parole da ripetere con lo shadowing. Il parlato dura 9:24. Chi parla mantiene un ritmo costante di circa 136 parole al minuto, comodo per lo shadowing. Solo il 70% delle parole rientra nelle 3.000 più comuni dell’inglese, quindi il lessico è impegnativo.

Vocaboli chiave di questo video

15 parole del video che vale la pena imparare, con pronuncia e significato:

Parola	Pronuncia	Significato
wire sostantivo	/ˈwaɪɚ/	filo, filo metallico
microwave sostantivo	/ˈmaɪkɹoʊˌweɪv/	microonda
deploy verbo	/dɪˈplɔɪ/	dispiegare, collocare
artery sostantivo	/ˈɑɹ.təɹ.i/	arteria
technique sostantivo	/tɛkˈniːk/	tecnica
balloon sostantivo	/bəˈlun/	palloncino
parallel aggettivo	/ˈpæ.ɹəˌlɛl/	parallelo
spider sostantivo	/ˈspaɪ̯dɚ/	ragno
establish verbo	/ɪˈstæb.lɪʃ/	stabilire, confermare
confirm verbo	/kənˈfɝm/	cresimare
simultaneously avverbio	/ˌsaɪmlˈteɪnɪəsli/	simultaneamente, allo stesso tempo
filter sostantivo	/ˈfɪltɚ/	filtro
segment sostantivo	/ˈsɛɡmɛnt/	segmento
hug verbo	/hʌɡ/	abbracciare
injection sostantivo	/ɪnˈd͡ʒɛk.ʃən/	iniezione

I phrasal verb che sentirai

Parola	Significato
rule out verbo	escludere

Pronuncia a cui fare attenzione

Chi parla usa 4 contrazioni e forme ridotte, come I'm, can't, we've. Pronunciale nella forma breve, così come le senti.

I suoni “th”: catheter /ˈkæθɪtɚ/, sheath /ʃiθ/
I suoni “sh” e “zh”: establish /ɪˈstæb.lɪʃ/, injection /ɪnˈd͡ʒɛk.ʃən/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, intervention /ɪntɚˈvɛnʃən/, aspiration /ˌæspəˈɹeɪʃən/
Parole lunghe — attenzione all’accento: simultaneously /ˌsaɪmlˈteɪnɪəsli/, superior /sʊˈpɪɹ.i.ɚ/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, mechanical /məˈkænəkəl/, intervention /ɪntɚˈvɛnʃən/

Come esercitarsi con questo video

Ascolta tutto il video una volta senza parlare e annota le parole che non conosci.
Fai shadowing frase per frase a velocità normale, ripetendo ognuna finché il tuo ritmo coincide con quello di chi parla.
Registrati e confronta con l’originale, facendo attenzione a parole come wire, microwave, deploy.

Cos'è la tecnica dello Shadowing?

Shadowing è una tecnica di apprendimento delle lingue supportata da studi scientifici, originariamente sviluppata per la formazione dei traduttori professionisti e resa popolare dal poliglotta Dr. Alexander Arguelles. Il metodo è semplice ma potente: ascolti un audio in inglese di madrelingua e lo ripeti immediatamente ad alta voce — come un'ombra che segue il parlante con un ritardo di solo 1–2 secondi. A differenza dell'ascolto passivo o degli esercizi di grammatica, lo shadowing costringe il tuo cervello e i muscoli della bocca a elaborare e riprodurre simultaneamente i modelli di discorso reale. La ricerca dimostra che migliora significativamente la precisione della pronuncia, l'intonazione, il ritmo, il discorso connesso, la comprensione dell'ascolto e la fluidità del parlato — rendendolo uno dei metodi più efficaci per la preparazione alla prova di speaking dell'IELTS e per la comunicazione reale in inglese.

Tecnica dello shadowing: leggi la guida completa passo dopo passo →

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Vocabolario e note di pronuncia per questa lezione

Vocaboli chiave di questo video

I phrasal verb che sentirai

Pronuncia a cui fare attenzione

Come esercitarsi con questo video

Cos'è la tecnica dello Shadowing?