シャドーイング練習: Carotid Artery Stenting - Tips & Tricks - YouTubeで英語スピーキングを学ぶ
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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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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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なぜこのビデオで話す練習をするべきか？
このビデオは、内頸動脈のステント留置手術に関する詳細なケーススタディを提供します。このような専門的な内容を通じて、医療英語に特化したボキャブラリーやフレーズを学ぶことができます。特に、YouTubeで英語学習を親しんでいる方にとって、実践的な場面で使える英語の表現を理解する絶好の機会です。また、手術の流れや考慮すべきリスクについて語られており、自然な話し方やトーンを学ぶことができます。
文法と表現の文脈
このビデオでは、いくつかの重要な文法構造や表現が使用されています。以下にそれらを紹介します：
- 「suggestive of」 - 「～を示唆する」という意味で、何かの事象や状態を説明する際に使われます。
- 「we plan for」 - 「～を計画する」という表現で、未来の行動について述べる際に使います。
- 「should be」 - 提案や義務を表す助動詞で、適切な手順を示す際によく使われます。
- 「look for」 - ～を探すという意味で、注意深く観察するという文脈で使われています。
- 「based on our measurement」 - 測定結果に基づくという表現で、データに基づいて意見を述べる時に有効です。
これらの構造を理解することで、IELTSスピーキング対策にも役立ちます。また、実用的なコンテキストに基づく学習は、英語での表現力向上に貢献します。
よくある発音の落とし穴
このビデオには、特に注意が必要な発音やアクセントがあります。以下の単語やフレーズを練習してみてください：
- carotid - 「カロティッド」と発音しますが、最初の音節が特に強調される点に注意が必要です。
- angiography - 「アンジオグラフィー」と発音され、口の動かし方に意識を向けることで、より自然な発音が可能になります。
- embolism - 「エンボリズム」と発音し、特に中間の音節が重要です。
これらの発音練習は、英語の発音を良くするだけでなく、shadowing siteやshadow speechの実践にも役立ちます。特に、医療関連の専門用語を正確に発音することは、専門職でのコミュニケーションにおいて非常に重要です。
シャドーイングとは？英語上達に効果的な理由
シャドーイング（Shadowing）は、もともとプロの通訳者養成プログラムで開発された言語学習法で、多言語習得者として知られるDr. Alexander Arguelles によって広く普及されました。方法はシンプルですが非常に効果的：ネイティブスピーカーの英語を聞きながら、1〜2秒の遅延で声に出してすぐに繰り返す——まるで「影（shadow）」のように話者を追いかけます。文法ドリルや受動的なリスニングと異なり、シャドーイングは脳と口の筋肉が同時にリアルタイムで英語を処理・再現することを強制します。研究により、発音精度、抑揚、リズム、連音、リスニング力、そして会話の流暢さが大幅に向上することが確認されています。IELTSスピーキング対策や自然な英語コミュニケーションを目指す方に特におすすめです。