쉐도잉 연습: SVINutes: Intracranial Atherosclerotic Disease: Key Considerations for Stenting - 영상으로 영어 말하기 배우기

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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.

이 영상으로 배울 영어 회화 기술

이 영상은 전문적인 주제를 다루는 대화에서 중요한 정보를 명확히 전달하는 법을 연습할 수 있습니다. 특히 복잡한 의학 용어(예: intracranial atherosclerotic disease, stenting)를 포함한 문장 구조를 이해하고, 논리적으로 내용을 정리하는 능력을 키울 수 있습니다. 또한 영상 속 발화자의 말을 따라하는 shadowing 연습을 통해 빠른 속도의 영어에도 익숙해질 수 있습니다.

들어야 할 발음 특징

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원어민처럼 말하는 방법

발화자의 리듬과 강세를 따라하는 것이 중요합니다. 영상에서 "key considerations", "significant risk", "long-term restenosis"와 같은 핵심 용어에는 강세를 두고 발음하며, 부가 정보가 포함된 구문은 상대적으로 빠르게 말합니다. 또한 의학 용어를 발음할 때는 정확성을 유지하면서도 자연스러운 속도를 유지하는 것이 관건입니다. shadowing site를 이용해 반복 연습하면, 발화자의 말투와 리듬을 점차 흡수할 수 있습니다. "shadow speak" 연습을 할 때는 먼저 영상을 듣고, 1-2초 지연시켜 따라하는 방법을 추천합니다. 이렇게 하면 발음 뿐만 아니라 문장 구조도 함께 익힐 수 있습니다.

영상 영어 공부는 실제 대화 상황에서의 영어 사용 능력을 키우는 데 효과적입니다. 이 영상을 이용해 shadow speech 연습을 지속적으로 하면, 전문적인 주제의 영어 회화도 자연스럽게 구사할 수 있게 될 것입니다.

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.