シャドーイング練習: SVINutes: Intracranial Atherosclerotic Disease: Key Considerations for Stenting - 動画で英語スピーキングを学ぶ
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Hello, I am Amir Hassan, and on Zvinitz today we will be talking about intracranial atherosclerotic disease, key considerations for stenting.
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ICAT is a significant cause of ischemic stroke, responsible for 10% of ischemic strokes in the US and up to 50% in Asia.
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In South Texas, we have a 20-30% incidence.
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The disease process, you have a lot of plaque buildup, which leads to stenosis, increasing stroke risk.
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The key stroke mechanisms include hemodynamic compromise, artery embolism, in-situ thrombosis, and perforator strokes.
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Current treatment approaches include medical management with anticoagulants, antiplatelets, and or statin therapy.
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Interventions that include stenting and angioplasty.
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On cases with hemodynamic compromise, stenting has significant superiority over medical therapy.
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In a patient with a basilar stenosis, as you see here on the CT correlating CT perfusion, would benefit this patient much more than medical therapy.
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Versus a perforator stroke alone, as you can see here, this patient would do much better with medical therapy than intracranial stenting.
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Quick overview of the Sampras trial.
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There was a significant risk of instant stenosis.
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There was a significant risk of ischemic strokes
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and what you had was the medical management arm doing significantly better than the intervention arm
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and the trial was prematurely terminated then fast forward several years
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and we have the weave trial
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and the weave trial results were published in stroke in april 2019
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and the main findings were
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if you stuck to the on-label primary analysis findings you had a 2.6 percent event rate of stroke
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or death within 72 hours versus
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if you were off-label those patients were collected in a registry
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and they had up to 23.9 percent risk of stroke or death within 72 hours.
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One of the lessons learned were adjacent perforators.
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You had to undersize the balloon in those lesions and your goal was 60 to 80 percent true lumen diameter.
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Also experience mattered.
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In studies where the enrollment sites had the experience of treating three cases or on on average 10 cases like in Sampras, you had a much higher event rate.
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Whereas in Weave, the average interventionist had placed 37 wingspan stents prior to enrollment.
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Those who had high experience, greater than 50 wingspan stents prior to their first patient enrollment in Weave had a 0% event rate.
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We have several studies that looked at our initial experience with the Resolute Onyx stent, balloon-mounted stent that is drug-coded, and then we looked at 30-day outcomes,
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comparing them to the Sampras medical arm patients with propensity score matching, and we had a multi-center study that included other balloon-mounted stents.
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And what we found was that most of these patients did significantly better if you were on label, meaning you had to treat the patient and wait for seven days,
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maximize medical management with dual anti-plitotherapy and statin therapy, and And we also found significant decreased restenosis rates,
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long-term restenosis, compared to the Wingspan study.
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And here are the publications so you can look at them yourselves.
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The main points here are your tips and your setup for support based on our experience.
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And a key point here is patient selection.
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Patients with severe tortuosity, type 3 arches, an M for a carotid artery,
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common carotid, those cases probably be much more aggressive with your medical therapy before approaching stenting.
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In patients that you do select for stenting, we are very aggressive with P2Y12 testing on all patients.
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If that P2Y12 number is greater than 200, switch the patients to Berlinta 90mg BID.
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My partner does use 60mg BID and we have not found a significant difference between my patients and his patients.
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We always use a bolt ballast or a BMX guide catheter.
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We find that's much more supportive.
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If treating anterior circulation, you will have a lot of difficulty with the radial approach, so we primarily prefer femoral access.
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If you're treating lesions proximal to the periclinoid segment of the carotid, Navian 058-115 is the most supportive DAC.
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If you're treating an MCA lesion, it doesn't cross the periclinoid ophthalmic segments, so a Cat5 or Sophia EX 115 cm is the preferred distal axis catheter.
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We always use Zoom 14 support wire, that is our preferred O14 wire, Synchro 2 support if you don't have the Zoom 14,
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or you can use the Aristotle 14 support wire.
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Regular Synchro 2 and Traxxas just don't have enough support.
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We highly recommend the Resolute Onyx 2x8 mm device because it can comfortably increase in size to about 3.25 with post-dilatation.
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And for all our MCA M1 lesions and our mid-bazilar lesions,
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your perforator-rich teratoids, I don't care if your MCA or your basilar already measures 3-3.5mm, we always use our Resolute Onyx 2x8.
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Thank you very much and have a great day.
この動画で英語学習する理由
医学的なトピックを話す場面は、専門用語や論理的な説明が多く、英語スピーキング練習に最適です。この動画では、「intracranial atherosclerotic disease」のような専門用語から「significant superiority over」のような比較表現まで、実践的な表現が満載です。shadowing siteで繰り返し練習することで、専門的な会話も自然に話せるようになり、発音やリズムも向上します。
文脈の中の文法と表現
- 「responsible for 10% of...」：原因を表す便利な表現です。例えば「This factor is responsible for 30% of the issues.」のように使えます。
- 「versus」：比較を示す単語で、「～に対して」と訳します。文中では「stenting versus medical therapy」のように使われ、議論の中で対比を明確にします。
- 「if you stuck to...」：「～に従うならば」という条件文で、仮定を表します。「If you stick to the plan, you'll succeed.」のように日常会話でも使えます。
発音の注意点
英語の発音を良くするために、いくつかのトリッキーな単語に注意しましょう。「intracranial」は「イントラクレイニアル」と発音し、「atherosclerotic」は「アセロスクレロティック」となります。また、「stenosis」は「ステノーシス」で、語尾の「s」を軽く発音するのがポイントです。shadowspeaksのような方法で繰り返し聞き、真似ることで、自然な発音が身につきます。
この動画を使ってshadowing練習を続ければ、英語のスピーキング力が確実に上達します。ぜひ毎日少しずつ取り組んでみてください！
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。