シャドーイング練習: Decision-making in complex aneurysms: Guilherme Dabus on tools, techniques and safe strategy - YouTubeで英語スピーキングを学ぶ

Dr. Davos, thank you to be here sharing with us all your knowledge with the faculty,

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Dr. Davos, thank you to be here sharing with us all your knowledge with the faculty,

giving solutions for the treatment of complex cases,

how to use the different tools in the management of complex cases.

So how do you think about the evolution of the newest tools and techniques for treating complex cases?

I mean, I think, you know,

if you think about their field for the last 30 years,

I mean, I've been in practice for almost 20 years,

and you see the evolution just doesn't stop,

which is a great thing.

I mean, you see the device that we have now to treat,

for example, brain aneurysms or acute stroke from large vasococlusions,

and also like other areas like the liquid embolix carotid stents

which also has evolved i mean it's it's just has been an unbelievable journey

and i think it's been great

because it really is benefiting the patients i mean it makes our life easier too you know

which is great but in

that you know we need to always to think about what is being the best for the patient

and i think these new tools are really increasing the chance of those patients having a good outcome

which in the end it's really what we care for.

Yes.

How do you feel about the...

or what do you think about the.. using flower diverters in bifurcation aneurysms?

Also, as a young neurosurgeon,

I am afraid about that.

Yeah, I mean, I think that's still a topic of debate.

We don't have a clear answer for that.

I think the most important thing,

and I tell this to my fellows,

and I think when I have conferences like this where there's people that have not had a lot of experience yet,

right like we had it's important to understand that those are tools

and again you need to look into the aneurysm

and understand what is going to be the best tool to treat the aneurysm what

so what's going to be the most effications or effective tool to treat

that aneurysm in a ratio

that is also like the safest procedure for the device right for

that patient right so i think that's the important thing

that we need to always think about there is a bifurcation aneurysm are are there potentially other options?

Yeah.

I mean, is this patient young?

Is this patient someone that can benefit from other endovascular or even surgical strategy?

Or there's no other option,

and maybe putting in flow diverter is the best option.

We don't have a lot of the clear answer for that.

I mean, I think we may have some better idea with some further on studies looking to specifically flow diverter into bifurcation,

but at this point, we don't have actually that answer.

So I think we need to see those as tools

that could be used to improve the patient outcome to treat the aneurysm.

But we don't have the clear answer for that,

so we need to understand where all the tools are,

all the possible strategies, and really decide what's going to be the best for that patient.

So in the case that you are using the cloud diverters in bifurcations,

what do you think are the key points to avoid the thrombosis of the side branch?

Yeah, I think, you know,

again, first of all, you need to see if that's the best strategy for that patient.

In our practice, we try to refrain from that.

So we do maybe a stent assisted co-embolization.

Now, if you can't because of whatever,

it's a fusiform aneurysm that may be better suited for a flutiver,

then we would do it.

And basically in terms like,

you know,

side branches usually in our experience what we can do is

increase a little bit the blood pressure make sure they remain

patent we usually do delayed angiogram after the flow diver display to make sure

that branch is still feeling in a normal time

if not you can use you know different strategies you can give uh glucopoing 2b3 inhibitors for example you know

that can improve because could be a clot

that is forming the surface of the stent

so there are things you can do also like try to put your flow diver on the dominant branch of

that bifurcation right so you decrease the risk of of having like an important schemic symptom.

So I think those are important things.

But again, I guess the key message here is that understanding the bifurcation endos,

see if there's other possible alternatives to that.

And if they're not, because of fusiform and you think the flow divert is the best treatment,

make sure you have a good execution of that

and make sure you do maybe a 15 minute delayed angiogram

to make sure the flow is completely along on to the side branches.

I think that's very helpful.

Okay.

So, there were any particular case that you consider particularly educational for young neurosurgeons?

I think, you know, to be quite honest,

all the cases are very educational.

Even for people to understand that maybe

that should not be what they should try if they're not experienced with a specific device.

Some of the cases here are difficult and some of the cases are done with people that have a really,

like, probably some of the maximal level of expertise with a certain device.

So I think it's very important the person needs to see,

okay, what is my limitation to do a case like this?

There are other strategies.

There's always other strategies.

So I think if you look into all the kids that were presented,

I think that's a key lesson to be learned.

You know, understand what's your strengths and what can you do that actually will help the patient achieve a good outcome.

But understanding that you have limitations and if you don't have a great expertise of specific device,

you shouldn't try them difficult case.

Okay.

And what's your opinion about the Latin American community in this meeting?

I mean, the Latin community,

like when you have like Link Americas, is always great.

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There's always a lot of people from Central and South America.

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There's a lot of people that come from the meeting that live in the U.S and practice here who are,

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you know, South American or Central American.

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So I think that's really enriches a lot like the discussion.

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I think we have different realities that we all learn to live with.

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And, you know, it's great to have discussions and debate about those cases.

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And if you look into the cases and the case that people present,

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I mean, you know, great work is done all over the world.

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So I think that's important that we recognize that as well.

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Yes.

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Thank you, Dr. Davos, to be here.

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You're very welcome.

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My pleasure.

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Thank you very much.

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