Shadowing Practice: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Learn English Speaking with Video
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I'm Dr. Asim Javed.
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I'm an international cardiologist working at Rawalpindi Institute of Cardiology in Pakistan.
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This is a series of talks to facilitate learning process for performing mechanical thrombectomies in acute ischemic stroke.
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Let's now discuss a bailout parallel strength strategy.
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This is a 58 year old gentleman with left ICR terminus
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occlusion two solumbra attempts had already failed having ruled out icad
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and considering this to be an embolic thing now is a good time to do the parallel stent technique in
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which in this case we wired acf first
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and then we took a tip injection in aca a1 segment to confirm
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that we are in the right place then we wire mcm1 confirm the wire position
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and mcm1 and place our micro catheter there so now
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that both the micro catheters are in place we deployed the first stent retriever in mca
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and then removed its micro catheter then we deployed the second micro catheter in aca
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and removed its micro catheter as well so we removed both the micro catheters
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and now we've got both stent retrievers deployed
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and we have the bare wires coming out and we are holding both the bare wires.
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And then the next thing we did was we removed both we removed both stent retrievers together and pulled out everything.
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But unfortunately we still could not establish flow.
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So what we could have done different was to use double
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-save technique whereby after deploying both stent retrievers the two ray bars are removed the micro catheters
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and then the aspiration catheter slides over the wires of the two stent retrievers
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and then both stents are pulled out simultaneously while doing suction through the aspiration catheter as well.
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So that gives you maximum success
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and in fact you can even have a balloon tip guide at that point and the balloon is also inflated.
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So that will increase maximum chances of success and reduce the chances of distal embolization.
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So this is exactly what is shown in this picture in a systematic way
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that first thing you do is you deploy the two micro
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catheters in the two arteries where you want them you never deploy one stent first
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and then try to wire the second artery your wire is not going to cross through the stent retriever
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and even if it crosses through the second stent retriever will entangle into the first stent retriever
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so you always wire first artery then you place your micro catheter in
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that artery then you remove the same wire
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and you do not deploy the stent at this point in time you take this wire
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and place it into the second artery
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and then you park your micro catheter in the second artery
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once both micro catheters are in place then you can bring
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in your stent retriever in any of these micro catheters deploy
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the first stent retriever then deploy the second stent retriever then remove both the micro catheters
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and the bare wires
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that are coming out of the guide catheter now you need to take them out of your wire connector simultaneously
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and then on top of these two wires you bring in your respiration catheter
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which could be SOFIA or REACT
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and then you take it right all the way to the clot
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and once it starts it once it hugs the clot that's the time you start your aspiration
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so now you are doing sort of solumbra with two stent retrievers
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and one aspiration catheter so this is the double safe technique and
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if you have a balloon tip guide you also deploy the
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inflate the balloon of the balloon tip guide at this point
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and then you pull out everything and you get the maximum chances of success
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so this is the parallel stent technique Why you need to remove the two micro catheters
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and you can't take aspiration catheter from the beginning because the two micro catheters cannot go simultaneously through the aspiration catheter.
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So we have to most likely deploy both the stent retrievers
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and micro catheters through the guide catheter and not through the aspiration catheter
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so this is a 45 year old lady with four hours
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history of left -sided hemiplegia patient had left ICA critical disease
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which was non -culprit but was cross -filling right ACA right common carotid artery was totally occluded
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so basically this was a case of acute on chronic total
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occlusion of right common carotid artery six French 90 centimeter guide sheath six French aspiration catheter and Raybar micro catheter was taken.
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Traxxas wire could not cross.
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Pilot 200 and Gaia CTO wires could not cross the occlusion as well.
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Hornet 14 wire was able to cross the occlusion with the help of Caraval micro catheter.
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Check injection through Caraval micro catheter tip was done to confirm true lumen.
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Sophia plus 6 French failed to cross the proximal occlusion site.
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So we plan to do POBA in presence of distal protection filter.
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7 mm spider FX filter was deployed in right internal kerotid artery
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and then right ICA osteoballooning was done with 4 .5 by 15 mm NC tract balloon.
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Post ballooning there was no flow in the kerotid.
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6 French aspiration catheter for aspiration was used for aspiration up to the spider effects.
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So we thought there was no reflow because of the spider effects blockage.
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But it could not establish flow.
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So then trexus wire was brought back into the internal carotid artery and spider effects was removed.
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Again aspiration was done with SOFIA plus
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and this time flow was established in ICA but ICA terminus occlusion was found to be occluded.
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but one minute later the carotid flow also stopped again.
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This time we decided to deal with austere ICA first and deployed carotid wall stent 7 by 30 millimeters.
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Then we went on to deal with ICA terminus occlusion
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and performed Solumbra with SOFIA plus and Solitaire X 4 by 40 millimeters
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but after three attempts of Solumbra ICA terminus still remain occluded.
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We decided to go with parallel stent technique.
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Right ACA could not be wired and was cross -filled from left ACA.
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So we placed both wires in superior and inferior deviance of MCA.
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Two Raybar microcatheters were placed in both MCA deviance.
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Two stent retriever solitaire X 4x40 mm were deployed in ICA terminus starting from proximal segments of M2 deviance.
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Both rebars were removed and SOFIA plus was brought in and then the whole assembly was removed as one unit.
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right ICA and MCA were re -canalyzed
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and right ACA was cross -filled through ACOM right ICA stent was also patent
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and this is our neurologist examining the patient two hours later in the ward
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and the other side is the bagu, the bagu
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and the bagu is the bagu and the bagu is the bagu
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and the bagu is the bagu and the bagu is the bagu and the bagu is the bagu
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This is the case of basilar reclution One attempt of ADAPT
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and two attempts of Sulembra failed to re -canalyze basilar artery
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We decided to go with parallel stent technique You can see wire going into left PCA across the distal basilar occlusion.
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Ribber was parked in left PCA and then second wire and micro catheter were taken into the right PCA.
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Now you can see two stent retrievers 4x40 mm deployed in both PCAs
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and SOFIA plus aspiration catheter in place just hugging the clot.
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Both stent retrievers and SOFIA were removed as one unit and this is a comparison of pre and post intervention DSA images.
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This is again pictorial representation of the parallel stent technique and now this is the patient 48 hours later.
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Vocabulary and speaking notes for this lesson
This video has 99 sentences and 1275 words to shadow. The speech runs for 9:24. The speaker talks at a steady 136 words per minute, a comfortable pace for shadowing. Only 70% of the words are among the 3,000 most common in English, so the vocabulary is demanding.
Key vocabulary in this video
15 words from the video worth learning, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| wire noun | /ˈwaɪɚ/ | Metal formed into a thin, even thread, now usually by being drawn through a hole in a steel die. |
| microwave noun | /ˈmaɪkɹoʊˌweɪv/ | An electromagnetic wave with wavelength between that of infrared light and radio waves. |
| deploy verb | /dɪˈplɔɪ/ | To prepare and arrange (originally military unit or units, i.e., to array troops) for use. |
| artery noun | /ˈɑɹ.təɹ.i/ | Any of the muscular- and elastic-walled blood vessels forming part of the circulation system by which blood is conveyed away from the heart regardless of its… |
| technique noun | /tɛkˈniːk/ | The practical aspects of a given art, occupation etc.; formal requirements. |
| balloon noun | /bəˈlun/ | An inflatable buoyant object, often (but not necessarily) round and flexible. |
| parallel adjective | /ˈpæ.ɹəˌlɛl/ | Equally distant from one another at all points. |
| spider noun | /ˈspaɪ̯dɚ/ | Any of various eight-legged, predatory arthropods, of the order Araneae, most of which spin webs to catch prey. |
| establish verb | /ɪˈstæb.lɪʃ/ | To make stable or firm; to confirm. |
| confirm verb | /kənˈfɝm/ | To strengthen; to make firm or resolute. |
| simultaneously adverb | /ˌsaɪmlˈteɪnɪəsli/ | Occurring at the same time. |
| filter noun | /ˈfɪltɚ/ | A device which separates a suspended, dissolved, or particulate matter from a fluid, solution, or other substance; any device that separates one substance from… |
| segment noun | /ˈsɛɡmɛnt/ | A length of some object. |
| hug verb | /hʌɡ/ | To cling closely together. |
| acute adjective | /əˈkjut/ | Brief, quick, short. |
Phrasal verbs you will hear
| Word | Pronunciation | Meaning |
|---|---|---|
| pull out verb | To withdraw; especially of military forces; to retreat. | |
| come out verb | /ˌkʌm ˈaʊt/ | To be discovered; to be revealed. |
| rule out verb | To cross an item out by drawing a straight line through it, as with a ruler. |
Pronunciation to watch
The speaker uses 4 contractions and reduced forms, such as I'm, can't, we've. Say them the short way, as you hear them.
- The “th” sounds: catheter /ˈkæθɪtɚ/, sheath /ʃiθ/
- The “sh” and “zh” sounds: establish /ɪˈstæb.lɪʃ/, injection /ɪnˈd͡ʒɛk.ʃən/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, intervention /ɪntɚˈvɛnʃən/, aspiration /ˌæspəˈɹeɪʃən/
- Long words — get the stress right: simultaneously /ˌsaɪmlˈteɪnɪəsli/, superior /sʊˈpɪɹ.i.ɚ/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, mechanical /məˈkænəkəl/, intervention /ɪntɚˈvɛnʃən/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Shadow it sentence by sentence at normal speed, repeating each one until your rhythm matches the speaker.
- Record yourself and compare with the original, paying attention to words like wire, microwave, deploy.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.