쉐도잉 연습: Carotid Artery Stenting - Tips & Tricks - YouTube로 영어 말하기 배우기

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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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이 비디오로 말하기 연습을 하는 이유

이 비디오 "Carotid Artery Stenting - Tips & Tricks"는 실제 의료 절차를 다루고 있어, 전문적인 용어와 문맥에서의 대화 연습에 매우 유용합니다. 특히, 영어 회화 연습을 통해 의학 관련 지식을 깊이 이해할 수 있으며, 이는 유튜브 영어 공부에 큰 도움이 됩니다. 수술 과정과 환자의 상태에 대한 설명은 shadow speech 연습에도 적합합니다. 본 비디오의 발표자는 자신감 있는 음성과 자연스러운 억양으로 중요한 정보를 전달하므로, 따라 하면서 자신의 발음을 개선할 수 있습니다.

문맥 속의 문법 및 표현

이 비디오에서 사용된 주요 구조를 분석해 보겠습니다:

  • “the procedure could be divided into” - 이 구문은 주어진 절차를 설명할 때 사용되며, 복잡한 내용을 보다 명확하게 전달하는 데 유용합니다.
  • “suggestive of” - 이 표현은 어떤 현상을 설명할 때 가능성을 나타냅니다. 예를 들어, “This location of infarct suggests deep watershed territory infarct”와 같은 문장에서 사용됩니다.
  • “to avoid” - 이 표현은 특정 행동을 하지 않기 위해 무엇을 해야 하는지를 설명합니다. “to avoid the exchange maneuver”와 같이 사용되어, 예방법이 필요할 때 유용합니다.
  • “should be” - 이 구조는 필수적인 사항을 강조하는 데 사용됩니다. 예를 들어, “Filter device should be placed in the straight segment”와 같이 사용되어 중요한 지침을 제공합니다.

일반적인 발음 함정

발음 연습 중 주의해야 할 몇 가지 난이도 높은 단어와 억양을 살펴보겠습니다:

  • “carotid” - 이 단어는 지역에 따라 발음이 다르게 들릴 수 있으므로 주의가 필요합니다.
  • “occlusion” - 이 단어는 발음 시 중음이 강하게 나도록 연습해야 합니다.
  • “angiography”와 “embolism” - 이 두 단어는 의학적 용어로, 정확한 발음으로 말하기가 어려울 수 있습니다. 이 단어들은 정기적으로 반복하여 연습하는 것이 좋습니다.

이러한 발음을 연습하면서 IELTS 스피킹와 같은 시험 대비에도 유리하므로, 영어 실력을 한층 더 강화할 수 있습니다.

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법

쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.

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