Практика Shadowing: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Изучайте разговорный английский по видео

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I'm Dr. Asim Javed.

Я доктор Асим Джавед.

I'm an international cardiologist working at Rawalpindi Institute of Cardiology in Pakistan.

This is a series of talks to facilitate learning process for performing mechanical thrombectomies in acute ischemic stroke.

Let's now discuss a bailout parallel strength strategy.

This is a 58 year old gentleman with left ICR terminus

occlusion two solumbra attempts had already failed having ruled out icad

and considering this to be an embolic thing now is a good time to do the parallel stent technique in

which in this case we wired acf first

and then we took a tip injection in aca a1 segment to confirm

that we are in the right place then we wire mcm1 confirm the wire position

and mcm1 and place our micro catheter there so now

that both the micro catheters are in place we deployed the first stent retriever in mca

and then removed its micro catheter then we deployed the second micro catheter in aca

and removed its micro catheter as well so we removed both the micro catheters

and now we've got both stent retrievers deployed

and we have the bare wires coming out and we are holding both the bare wires.

And then the next thing we did was we removed both we removed both stent retrievers together and pulled out everything.

But unfortunately we still could not establish flow.

So what we could have done different was to use double

-save technique whereby after deploying both stent retrievers the two ray bars are removed the micro catheters

and then the aspiration catheter slides over the wires of the two stent retrievers

and then both stents are pulled out simultaneously while doing suction through the aspiration catheter as well.

So that gives you maximum success

and in fact you can even have a balloon tip guide at that point and the balloon is also inflated.

So that will increase maximum chances of success and reduce the chances of distal embolization.

So this is exactly what is shown in this picture in a systematic way

that first thing you do is you deploy the two micro

catheters in the two arteries where you want them you never deploy one stent first

and then try to wire the second artery your wire is not going to cross through the stent retriever

and even if it crosses through the second stent retriever will entangle into the first stent retriever

so you always wire first artery then you place your micro catheter in

that artery then you remove the same wire

and you do not deploy the stent at this point in time you take this wire

and place it into the second artery

and then you park your micro catheter in the second artery

once both micro catheters are in place then you can bring

in your stent retriever in any of these micro catheters deploy

the first stent retriever then deploy the second stent retriever then remove both the micro catheters

and the bare wires

that are coming out of the guide catheter now you need to take them out of your wire connector simultaneously

and then on top of these two wires you bring in your respiration catheter

which could be SOFIA or REACT

and then you take it right all the way to the clot

and once it starts it once it hugs the clot that's the time you start your aspiration

so now you are doing sort of solumbra with two stent retrievers

and one aspiration catheter so this is the double safe technique and

if you have a balloon tip guide you also deploy the

inflate the balloon of the balloon tip guide at this point

and then you pull out everything and you get the maximum chances of success

so this is the parallel stent technique Why you need to remove the two micro catheters

and you can't take aspiration catheter from the beginning because the two micro catheters cannot go simultaneously through the aspiration catheter.

So we have to most likely deploy both the stent retrievers

and micro catheters through the guide catheter and not through the aspiration catheter

so this is a 45 year old lady with four hours

history of left -sided hemiplegia patient had left ICA critical disease

which was non -culprit but was cross -filling right ACA right common carotid artery was totally occluded

so basically this was a case of acute on chronic total

occlusion of right common carotid artery six French 90 centimeter guide sheath six French aspiration catheter and Raybar micro catheter was taken.

Traxxas wire could not cross.

Pilot 200 and Gaia CTO wires could not cross the occlusion as well.

Hornet 14 wire was able to cross the occlusion with the help of Caraval micro catheter.

Check injection through Caraval micro catheter tip was done to confirm true lumen.

Sophia plus 6 French failed to cross the proximal occlusion site.

So we plan to do POBA in presence of distal protection filter.

7 mm spider FX filter was deployed in right internal kerotid artery

and then right ICA osteoballooning was done with 4 .5 by 15 mm NC tract balloon.

Post ballooning there was no flow in the kerotid.

6 French aspiration catheter for aspiration was used for aspiration up to the spider effects.

So we thought there was no reflow because of the spider effects blockage.

But it could not establish flow.

So then trexus wire was brought back into the internal carotid artery and spider effects was removed.

Again aspiration was done with SOFIA plus

and this time flow was established in ICA but ICA terminus occlusion was found to be occluded.

but one minute later the carotid flow also stopped again.

This time we decided to deal with austere ICA first and deployed carotid wall stent 7 by 30 millimeters.

Then we went on to deal with ICA terminus occlusion

and performed Solumbra with SOFIA plus and Solitaire X 4 by 40 millimeters

but after three attempts of Solumbra ICA terminus still remain occluded.

We decided to go with parallel stent technique.

Right ACA could not be wired and was cross -filled from left ACA.

So we placed both wires in superior and inferior deviance of MCA.

Two Raybar microcatheters were placed in both MCA deviance.

Two stent retriever solitaire X 4x40 mm were deployed in ICA terminus starting from proximal segments of M2 deviance.

Both rebars were removed and SOFIA plus was brought in and then the whole assembly was removed as one unit.

right ICA and MCA were re -canalyzed

and right ACA was cross -filled through ACOM right ICA stent was also patent

and this is our neurologist examining the patient two hours later in the ward

and the other side is the bagu, the bagu

and the bagu is the bagu and the bagu is the bagu

and the bagu is the bagu and the bagu is the bagu and the bagu is the bagu

This is the case of basilar reclution One attempt of ADAPT

and two attempts of Sulembra failed to re -canalyze basilar artery

We decided to go with parallel stent technique You can see wire going into left PCA across the distal basilar occlusion.

Ribber was parked in left PCA and then second wire and micro catheter were taken into the right PCA.

Now you can see two stent retrievers 4x40 mm deployed in both PCAs

and SOFIA plus aspiration catheter in place just hugging the clot.

Both stent retrievers and SOFIA were removed as one unit and this is a comparison of pre and post intervention DSA images.

This is again pictorial representation of the parallel stent technique and now this is the patient 48 hours later.

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Лексика и советы по произношению к этому уроку

В этом видео 99 предложений и 1275 слов для шедоуинга. Речь длится 9:24. Говорящий держит ровный темп — около 136 слов в минуту, удобный для шедоуинга. Только 70% слов входят в 3000 самых частых слов английского языка, поэтому лексика сложная.

Ключевая лексика этого видео

15 слов из видео, которые стоит выучить, с произношением и значением:

Слово	Произношение	Значение
wire существительное	/ˈwaɪɚ/	про́волока, про́вод
microwave существительное	/ˈmaɪkɹoʊˌweɪv/	микроволна́
deploy глагол	/dɪˈplɔɪ/	развёртывать, разверну́ть
artery существительное	/ˈɑɹ.təɹ.i/	арте́рия
technique существительное	/tɛkˈniːk/	те́хника
balloon существительное	/bəˈlun/	возду́шный шар
parallel прилагательное	/ˈpæ.ɹəˌlɛl/	паралле́льный
spider существительное	/ˈspaɪ̯dɚ/	пау́к
establish глагол	/ɪˈstæb.lɪʃ/	устана́вливать, установи́ть
confirm глагол	/kənˈfɝm/	укрепля́ть, укрепи́ть
simultaneously наречие	/ˌsaɪmlˈteɪnɪəsli/	одновре́менно
filter существительное	/ˈfɪltɚ/	фильтр
segment существительное	/ˈsɛɡmɛnt/	отре́зок, сегме́нт
hug глагол	/hʌɡ/	обнима́ться, обня́ться
acute прилагательное	/əˈkjut/	о́стрый, то́нкий

Фразовые глаголы, которые вы услышите

Слово	Произношение	Значение
pull out глагол		выходи́ть, вы́йти
come out глагол	/ˌkʌm ˈaʊt/	выходи́ть, вы́йти
rule out глагол		исключа́ть, исключи́ть

Произношение, на которое стоит обратить внимание

Говорящий использует 4 сокращённых и редуцированных форм, например I'm, can't, we've. Произносите их коротко, так, как слышите.

Звуки «th»: catheter /ˈkæθɪtɚ/, sheath /ʃiθ/
Звуки «sh» и «zh»: establish /ɪˈstæb.lɪʃ/, injection /ɪnˈd͡ʒɛk.ʃən/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, intervention /ɪntɚˈvɛnʃən/, aspiration /ˌæspəˈɹeɪʃən/
Длинные слова — следите за ударением: simultaneously /ˌsaɪmlˈteɪnɪəsli/, superior /sʊˈpɪɹ.i.ɚ/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, mechanical /məˈkænəkəl/, intervention /ɪntɚˈvɛnʃən/

Как заниматься с этим видео

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Что такое техника Shadowing?

Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.

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Практика Shadowing: 12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke - Изучайте разговорный английский по видео

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