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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Take.
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Bu dersin kelimeleri ve konuşma notları
Bu videoda gölgeleme çalışması için 99 cümle ve 1275 kelime var. Konuşma bölümü 9:24 sürüyor. Konuşmacı dakikada yaklaşık 136 kelimelik dengeli bir hızla konuşuyor; gölgeleme için rahat bir tempo. Kelimelerin yalnızca %70’i İngilizcede en sık kullanılan 3.000 kelime arasında, bu yüzden kelime dağarcığı zorlayıcı.
Bu videodaki önemli kelimeler
Videodan öğrenmeye değer 15 kelime, telaffuzu ve anlamıyla:
| Kelime | Telaffuz | Anlam |
|---|---|---|
| wire isim | /ˈwaɪɚ/ | tel |
| microwave isim | /ˈmaɪkɹoʊˌweɪv/ | mikrodalga |
| artery isim | /ˈɑɹ.təɹ.i/ | arter, atardamar |
| technique isim | /tɛkˈniːk/ | teknik |
| balloon isim | /bəˈlun/ | balon |
| parallel sıfat | /ˈpæ.ɹəˌlɛl/ | paralel |
| spider isim | /ˈspaɪ̯dɚ/ | örümcek |
| establish fiil | /ɪˈstæb.lɪʃ/ | yerleştirmek |
| confirm fiil | /kənˈfɝm/ | onaylamak, tasdik etmek |
| simultaneously zarf | /ˌsaɪmlˈteɪnɪəsli/ | aynı anda |
| filter isim | /ˈfɪltɚ/ | filtre |
| hug fiil | /hʌɡ/ | sarılmak |
| acute sıfat | /əˈkjut/ | keskin |
| injection isim | /ɪnˈd͡ʒɛk.ʃən/ | enjeksiyon |
| superior sıfat | /sʊˈpɪɹ.i.ɚ/ | üstün |
Duyacağınız deyimsel fiiller
| Kelime | Telaffuz | Anlam |
|---|---|---|
| come out fiil | /ˌkʌm ˈaʊt/ | çıkmak |
Dikkat edilecek telaffuzlar
Konuşmacı I'm, can't, we've gibi kısaltılmış biçimleri 4 kez kullanıyor. Bunları duyduğunuz gibi kısa söyleyin.
- “th” sesleri: catheter /ˈkæθɪtɚ/, sheath /ʃiθ/
- “sh” ve “zh” sesleri: establish /ɪˈstæb.lɪʃ/, injection /ɪnˈd͡ʒɛk.ʃən/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, intervention /ɪntɚˈvɛnʃən/, aspiration /ˌæspəˈɹeɪʃən/
- Uzun kelimeler — vurguyu doğru yere koyun: simultaneously /ˌsaɪmlˈteɪnɪəsli/, superior /sʊˈpɪɹ.i.ɚ/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, mechanical /məˈkænəkəl/, intervention /ɪntɚˈvɛnʃən/
Bu videoyla nasıl çalışılır
- Videonun tamamını konuşmadan bir kez dinleyin ve bilmediğiniz kelimeleri not edin.
- Normal hızda cümle cümle tekrar edin; ritminiz konuşmacıyla aynı olana kadar her cümleyi yineleyin.
- Kendinizi kaydedin ve orijinaliyle karşılaştırın; wire, microwave, artery gibi kelimelere özellikle dikkat edin.
Gölgeleme Tekniği Nedir?
Gölgeleme, başlangıçta profesyonel tercüman eğitimi için geliştirilen ve çok dilli Dr. Alexander Arguelles tarafından popüler hale getirilen, bilim destekli bir dil öğrenme tekniğidir. Yöntem basit ama güçlüdür: ana dili İngilizce olan bir sesi dinler ve hemen yüksek sesle tekrar edersiniz — konuşmacıyı 1-2 saniye gecikmeyle takip eden bir gölge gibi. Pasif dinleme veya dilbilgisi alıştırmalarının aksine, gölgeleme beyninizi ve ağız kaslarınızı gerçek konuşma kalıplarını eşzamanlı olarak işlemeye ve yeniden üretmeye zorlar. Araştırmalar, telaffuz doğruluğu, tonlama, ritim, bağlı konuşma, dinleme anlama ve konuşma akıcılığını önemli ölçüde geliştirdiğini göstermektedir — bu da onu IELTS Konuşma hazırlığı ve gerçek dünya İngilizce iletişimi için en etkili yöntemlerden biri yapar.