Shadowing Practice: PCI calcium modification: Updated approach, Device deliverability - Learn English Speaking with Video
Bir pratik modu seçin
Her mod tam ekran bir pratik odası açar.
213 cümleler
Cümleler çok kısa veya çok uzun ise, ayarlamak için Düzenle'ye tıklayın.
1
i want to talk today about the deliverability
2
and crossing profiles of various pci devices we have especially the various specialty balloons we have
3
and i want to provide updates on pci calcium modification strategy
4
and i strongly recommend
5
that you review my pci of severe coronary calcium talk as
6
my current presentation will complement the prior one i want to
7
start by talking about the crossing profiles of various tools we have one iv little tripsy balloon
8
or shockwave balloon it has a thick profile of about 0.45 inch
9
or 1.2 millimeters and that is the main limitation of ivl is
10
that it may not cross a severely calcified lesion it needs a big channel typically over that
11
1.2 to 1.5 millimeters and that's why it needs extensive vessel preparation before you can advance it
12
and sometimes you need a therectomy before you can advance it the crossing profile of lithotripsy is close to
13
that of stent except sent have the added disadvantage of less flexibility
14
and metal encroaching onto calcium pieces lithotripsy comes in 2.5 to 4 millimeter diameters and has a length of 12 millimeters.
15
Now this is regarding drug coated balloons.
16
They have a 0.032 inch crossing profile better than lithotripsy.
17
This is Wolverine cutting balloon.
18
It has a 0.037 inch crossing profile also better than
19
IV lithotripsy and it comes in 2 to 4 millimeter diameter whereas lithotripsy is 2.5 to 4 millimeter diameter
20
and it comes in 6,
21
10 and 15 millimeter lengths.
22
Typically I use 10 millimeter length which improves the deliverability of the cutting balloon compared to the 15 millimeters.
23
now this is the OPN super non-compliant very high pressure balloon it has a crossing profile of 0.028 inch
24
which is better than lithotripsy and slightly better than cutting balloon
25
and DCB and that's a major advantage of OPN
26
and the OPN balloon has double non-compliant layers
27
and those two layers reducing its compliance and make it super non-compliant
28
and allow it to be inflated at very high pressure with limited expansion and a low risk of balloon rupture.
29
And you can see here on that inflation chart that compared to other non-compliant balloon,
30
the OPN balloon, the red one has the flattest compliance curve and even at an inflation pressure of 35 millimeter
31
a three millimeter balloon will only expand to about 3.4 millimeters
32
you can see here the balloon compliance chart three millimeter balloon at a 35 atmosphere will expand to 3.36 millimeters
33
and And when using OPN balloon,
34
it's recommended to downsize your diameter by half millimeter compared to the reference vessel diameter.
35
So if you're dilating it in a vessel that is 3.5 millimeter by your IVUS imaging,
36
you should use a 3 millimeter OPN balloon
37
and inflate it to 35 up to 40 atmosphere year
38
and here is a summary of the crossing profiles
39
and deliverability of the various tools we have today in our
40
cath lab one you have the compliant balloon then you have
41
the non-compliant balloon then you have the super non-compliant balloon opn then close to it
42
but behind it you have the 6 and 10 millimeter wolverine cutting balloons
43
and the dcb then behind
44
that you have the iv little tripsi balloon then behind all
45
those you have the stand like i said the stent crossing profile is close to
46
that of little tripsi balloon but it has the added disadvantage of less flexibility from
47
that metal and the metal encroaching on the calcium.
48
And to cross with IV little tripsy balloon,
49
you need at least 1.3 to 1.5 millimeter channel,
50
whereas you need one millimeter or less for OPN balloon and probably around one millimeter for cutting balloon and for DCB.
51
Now I will move on to provide an update on calcium modification strategy for severe coronary calcium.
52
This is my prior algorithm,
53
and I will provide an update of that in light of the two new major trials.
54
Keep in mind the fluoroscopic definition of severe coronary calcium,
55
which is calcium on both sides of the vessel on still images
56
and the IVUS or OCT definition of severe coronary calcium
57
which is more than 270 degree arc over more than 5 millimeter
58
or 360 degree arc for any length or a calcified nodule
59
which is a piece of eccentric calcium protruding bulging into the lumen
60
And keep in mind that having severe coronary calcium does not automatically dictate calcium modification strategy,
61
as has been shown in the atherectomy trials,
62
such as Eclipse trial with orbital atherectomy,
63
where MACE outcomes were worse with orbital atherectomy compared to a standard balloon strategy
64
and as shown also in the rotaxis and prepare calc trial with rotational atherectomy,
65
where outcomes were not worse but were not improved with rotational atherectomy.
66
You always had around close to 15% of patients who needed atherectomy because they were balloon uncrossable or undilatable.
67
And that's why calcetal modification is always definitely required in cases of balloon uncrossable lesion where you need atherectomy
68
or in cases of balloon undilatable lesion where you need atherectomy or lithotripsy or OPN or cutting balloon.
69
And we call the lesion undilatable
70
when it does not yield with a one-to-one non-compliant balloon inflated at high pressure 18 to 20 atmosphere
71
and it does not yield clearly in two orthogonal fluoroscopic views.
72
Always verify that the balloon is yielding in two fluoroscopic views.
73
Now, here are the two major trials presented at TCT.
74
One is victory trial of OPN versus lithotripsy in severe coronary calcium.
75
IVL was size 1 to 1 to the reference lumen diameter,
76
meaning EEL to EEL diameter,
77
typically average of the proximal and distal reference lumen diameters,
78
and it was inflated up to 6 atm.
79
That's how typically we size IVL,
80
we size it 1 to 1 to the reference lumen,
81
whereas OPN was size minus half millimeter to the reference lumen,
82
and it was inflated up to 40 atmospheres.
83
And in that victory trial,
84
we achieved the same stent expansion of approximately 85% of the mean reference proximal and distal area with both OPN and IBL.
85
So they were both as efficacious.
86
And in both cases, rotablation was required before ballooning in about 15% of the patients.
87
And there was no difference in perforation rates,
88
despite using very high pressure with OPN up to 40 atmosphere.
89
OPN has a lower profile and was easier to deliver than IVL
90
and required less balloons and less predilatation to allow its delivery.
91
So the procedure was faster with OPN and similarly efficacious in terms of stent expansion by OCT.
92
The only disadvantage is that we had numerically but not statistically more dissections with OPN.
93
And there are two potential pitfalls with OPN in victory trial.
94
One, the trial excluded osteo disease as well as stent-related issues such as stent underexpansion or instant calcified neoarthrosclerosis.
95
This does not mean that OPN cannot be used in those two instances.
96
It's just that it has not been shown to be equivalent to IVL in those two settings.
97
And the second potential shortcoming of OPN is that since we had more dissections numerically with OPN,
98
it could hypothetically be problematic when we're planning to use DCB as a standalone therapy.
99
So it is potentially problematic as a prep for DCB,
100
where you want to reduce our dissections, especially flow limiting dissections.
101
And here you can see in that trial that you needed more device as a preparation for IVL compared to OPN.
102
And you can see here that at the level of the stenosis,
103
the luminal channel diameter was around 1.5 and at least 1.3 millimeter.
104
And that's kind of the channel you need in order to be able to advance IVL.
105
And you can see here that OPN and IVL achieved similar stent expansion,
106
including a similar rate of stent expansion,
107
more than 80% of the reference and more than 90% of the reference
108
and you can see here the numeric trend toward more dissections with opn
109
but not flow limiting dissections the second major trial presented at
110
tct 2025 is shortcut trial of cutting balloon versus ivl in
111
severe calcium again here ivl was sized one to one to the reference luminal diameter
112
and the inflation pressure was 5.5 plus
113
or minus 3.5 probably best to limit it to 6 atmosphere
114
as in the prior victory trial the cutting balloon like opn
115
was sized minus 0.5 millimeter to the reference lumen diameter
116
and it was inflated to a pressure of 16 to 20 atmosphere
117
and the mean pressure was 17 plus or minus 3.5 atmosphere
118
and keep that number in mind this is different from the traditional teaching
119
that cutting balloon should only be inflated to 12 atmosphere
120
so here they went higher in that trial and that's key to the success of cutting balloon in that trial.
121
Unlike Victory where only 15 percent of patients had pre-balloon rotational atherectomy,
122
in this trial 50 percent had planned rotational atherectomy before IVL or cutting balloon,
123
the so-called rota cut or rota shock.
124
This is an acknowledgement that atherectomy is unavoidable in some cases,
125
evidently the balloon uncrossable cases,
126
but also some balloon undilatable cases where the channel is not large enough to allow you to advance lithotripsy or cutting balloon.
127
And in that shortcut trial,
128
both devices, cutting balloon and lithotripsy,
129
achieved the same percent stent expansion at the site of maximum calcium.
130
They had the same perforation rate.
131
And again, we had a trend toward more dissection with cutting balloon compared to lithotripsy.
132
That's always an advantage of lithotripsy,
133
the lowest dissection rate and a very low perforation rate.
134
And this non-inferiority of cutting balloon compared to lithotripsy was seen in patients who received a planned rotation atherectomy,
135
but also in those who did not receive
136
rotational atherectomy if you adjust your analysis in terms of percent stent expansion compared to the reference vessel size.
137
And here again, you can see that little tripsy required more balloon preparation before you could advance it compared to cutting balloon.
138
And here I want to show quickly another trial,
139
COPS randomized trial, which was a randomized trial of cutting balloon downsized by 0.5 millimeter to the reference diameter versus NC balloon,
140
not versus lithotripsy.
141
And this trial showed superiority of cutting balloon compared to NC balloon in terms of MSA,
142
minimal stent area, in terms of stent expansion,
143
including stent expansion at the calcium site.
144
However, in that study, we had numerically more perforations with cutting balloon,
145
and this was partly attributed to the fact that cutting balloon was downside only 0.25 millimeter in one of the perforation cases,
146
and it was inflated to higher pressure,
147
18 plus or minus 5 atmosphere in that trial,
148
which tells me that to stay safe with the cutting balloon,
149
try to limit your inflation pressure to no more than 18,
150
maximum maybe 20 atmosphere.
151
And this is my updated approach to calcium modification strategy.
152
And keep in mind that not all severe coronary calcium requires the sophisticated calcium modification strategies here.
153
You may start with one-to-one non-compliant balloon,
154
and if that non-compliant balloon yields in two orthogonal in geographic views,
155
that may be enough.
156
You definitely need the advanced calcium modification strategy if you have balloon uncrossable lesion,
157
in which case you need atherectomy typically rotational or orbital
158
or sometimes in the most difficult cases you will need laser
159
as a preparation to allow you to advance a micro catheter to exchange for the rota
160
or orbital wires so balloon uncrossable you definitely need atherectomy and you definitely need some calcio modification if you have balloon
161
undilatable lesion, meaning that non-compliant balloon is not yielding properly in one or two views.
162
And here you can use either atherectomy or lithotripsy or cutting or OPN balloons.
163
Now, aside from that number one,
164
which is most important, we may favor planning upfront calcium modification strategy,
165
the denser and thicker and longer that severe coronary calcium,
166
also the more you have of iris features.
167
For example, you have not just an arc of calcium of 270 more than 5 millimeter,
168
it's way longer than 5 millimeter,
169
or you have long 360 degree of calcium,
170
or you have multiple spots of calcified nodule.
171
And in those cases, you will need a therectomy or the specialty balloons.
172
Now I said balloon uncrossable lesion,
173
you definitely need a therectomy.
174
Now regarding balloon undilatable lesion,
175
meaning the lesion that doesn't yield with an NC balloon.
176
Here you can either do a therectomy or you can do those specialty balloon,
177
IVL or cutting or OPN balloon.
178
They may work if you can create a channel to allow the advancement of those balloons.
179
And here is where OPN is more advantageous than lithotripsy,
180
particularly in light of its efficacy in victory trial.
181
The OPN has a smaller profile and can be advanced probably in a 1 mm channel or less,
182
whereas you probably need close to 1.5 mm channel for lithotripsy balloon.
183
So for balloon undilatable lesions,
184
particularly when you expect a more difficult crossing and delivery,
185
you may start with OPN,
186
especially that victory trial shows us that OPN often requires less preparation than lithotripsy.
187
and if the lesion does not yield with OPN at 40 atmosphere
188
or your calcium does not break on the post-balloon iris then you can upscale to little trip C balloon
189
or even to a therectomy if you don't have any obvious in geographic dissection type C or beyond.
190
You may also start with cutting balloons since its profile is lower than lithotripsy
191
and it achieved similar stent expansion and calcium fracture rate in rota cut trial.
192
Another idea is that the thicker and denser and longer your calcium
193
and the more complex calcium features you have by IVUS or in geographically,
194
the more likely you are to require a therectomy rather than specialty balloons.
195
And within the specialty balloons,
196
the more likely you are to require little trypsy rather than cutting or OPN balloon.
197
And the decision to start with a therectomy rather than specialty balloons
198
depend on your perceived complexity and length and density of
199
that calcium on both the angiogram as well as your intravascular imaging
200
and whether you can create enough of a channel to allow the advancement of those specialty balloons,
201
starting with a small compliant balloon,
202
then gradual sizes of non-compliant balloons,
203
and also on how difficult it is to advance your IVUS catheter,
204
particularly the lower profile Avego mechanical transducer catheter or the OCT catheter.
205
If you have difficulty advancing those lower profile catheter,
206
you're likely to require a thorectomy up front rather than specialty balloons.
207
You may start in some of those cases OPN or cutting balloon,
208
but you're more likely to require bailout with a thorectomy or lithotripsy in those cases.
209
Another third idea I'm adding here is that if you're planning to do DCB in lung disease,
210
disease, small vessels, distal disease.
211
It's probably better to do IVL versus OPN or cutting balloon because we know IVL inherently causes less dissections,
212
and therefore you're more likely to achieve a very good balloon-only result
213
that allows you to finish the case with DCB as opposed to stenting the lesion.
Uygulamayı İndir
Akıcı konuşmak için ihtiyacınız olan her şey
AI TelaffuzHer cümleyi puanla
IPA AlıştırmasıHer sesi ustalaştır
Kelime BilgisiKelime bankanızı oluşturun
Kelime OyunuOynarken öğrenin
FOR YOU
Video Öner
C25
53 cümleler
SVINutes: Intracranial Atherosclerotic Disease: Key Considerations for Stenting
University StudentsWorking Adults
C14
311 cümleler
Handy CSS layout patterns, and fun ways to elevate them
Daily ConversationUniversity StudentsWorking Adults
C11
20 cümleler
Manufacturing Equipment at Z-AXIS
Daily ConversationUniversity StudentsWorking Adults
C11
91 cümleler
How To: Ultrasound for Pneumothorax Case Study Video
Daily ConversationUniversity StudentsWorking Adults
C1101 cümleler
SANS Stormcast Wednesday, November 11th, 2026: Microsoft Patch Tuesday Outlook Spoofing (CVE-20…
Daily ConversationUniversity StudentsWorking Adults
C12
15 cümleler
CO2 Fractional Laser Explained - Acne Scar removal, Skin Rejuvenation｜London
Daily ConversationUniversity StudentsWorking Adults
C12
283 cümleler
Why Memory Prices Are Crazy High
Daily ConversationUniversity StudentsWorking Adults
C13
131 cümleler
Understanding BGA Pads: Solder Mask Defined vs Non-Defined
Business EnglishUniversity StudentsWorking Adults
C11
4 cümleler
Ambr®️ 250 High Throughput Perfusion Product Tutorial - Learn with Sartorius
Business EnglishUniversity StudentsWorking Adults
C11
16 cümleler
Cleft Lip & Cleft Palate: Pediatrics - Alterations in Health | @LevelUpRN
Business EnglishUniversity StudentsWorking Adults
C11
653 cümleler
How We Incorporate Patient Priorities Care into Our Clinical Pharmacy Practices
Daily ConversationUniversity StudentsWorking Adults
C12
20 cümleler
How Does Your Blood Flow
University StudentsWorking Adults
Bu dersin kelimeleri ve konuşma notları
Bu C2 seviyesindeki konuşma dersi “PCI calcium modification: Updated approach, Device deliverability” videosuna dayanıyor. En çok tekrarlanan kelimeler: balloon, opn, millimeter, calcium, cutting. Bu videoda gölgeleme çalışması için 213 cümle ve 2480 kelime var. Konuşma bölümü 19:50 sürüyor. Konuşmacı dakikada yaklaşık 125 kelimelik dengeli bir hızla konuşuyor; gölgeleme için rahat bir tempo. Kelimelerin yalnızca %72’i İngilizcede en sık kullanılan 3.000 kelime arasında, bu yüzden kelime dağarcığı zorlayıcı.
Bu videodaki önemli kelimeler
Videodaki en ileri düzey 15 kelime, telaffuzu ve anlamıyla:
| Kelime | Telaffuz | Anlam |
|---|---|---|
| balloon isim | /bəˈlun/ | balon |
| calcium isim | /ˈkælsi.əm/ | kalsiyum |
| millimetre isim | milimetre | |
| lithotripsy isim | /ˈlɪθ.əˌtɹɪp.si/ | litotripsi |
| stent isim | /stɛnt/ | stent |
| compliant sıfat | /kəmˈplaɪənt/ | itaatkâr, uysal |
| lesion isim | /ˈliːʒən/ | lezyon, yaralanma |
| diameter isim | /daɪˈæmɪdɚ/ | çap |
| inflate fiil | /ɪnˈfleɪt/ | şişmek |
| catheter isim | /ˈkæθɪtɚ/ | sonda, kateter |
| minus | /ˈmaɪ.nəs/ | eksi |
| calcify fiil | /ˈkælsɪfaɪ/ | kireçleşmek, kireçlenmek |
| disadvantage isim | /ˌdɪsədˈvæntɪd͡ʒ/ | dezavantaj |
| shortcut isim | /ˈʃɔːtkʌt/ | kestirme, kestirme yol |
| wolverine isim | /ˌwʊlvəˈɹiːn/ | kutup porsuğu, ayı sansarı |
Bu videodaki dil bilgisi
Konuşmacının en çok kullandığı yapılar, videodaki sözcüklerin aynısıyla:
| Yapı | Videoda |
|---|---|
| Edilgen yapı be + fiilin üçüncü hâli — kimin yaptığı değil, ne olduğu önemli | be inflated · has been shown · were not improved |
| Present perfect have/has + fiilin üçüncü hâli — geçmişte olan ama şimdi de önemli olan bir eylem | has been shown · has not been shown |
| İlgi cümlecikleri who / which + cümle — bir kişi ya da şey hakkında ek bilgi | those who did · trial, which was |
Dikkat edilecek telaffuzlar
Konuşmacı you're, doesn't, don't gibi kısaltılmış biçimleri 9 kez kullanıyor. Bunları duyduğunuz gibi kısa söyleyin.
- “th” sesleri: lithotripsy /ˈlɪθ.əˌtɹɪp.si/, catheter /ˈkæθɪtɚ/, orthogonal /ɔɹˈθɑ.ɡə.nəl/, algorithm /ˈælɡəɹɪðm̩/
- “sh” ve “zh” sesleri: lesion /ˈliːʒən/, dissection /dɪˈsɛkʃən/, modification /ˌmɑdɪfɪˈkeɪʃən/, specialty /ˈspɛʃ.əl.ti/, rotational /ɹoʊˈteɪʃənəl/
- Uzun kelimeler — vurguyu doğru yere koyun: lithotripsy /ˈlɪθ.əˌtɹɪp.si/, diameter /daɪˈæmɪdɚ/, modification /ˌmɑdɪfɪˈkeɪʃən/, coronary /ˈkɔɹənɛɹi/, rotational /ɹoʊˈteɪʃənəl/
Türkçe konuşanların zorlandığı sesler:
- /w/ — dudaklar yuvarlak, /v/ değil: wolverine /ˌwʊlvəˈɹiːn/, microwave /ˈmaɪkɹoʊˌweɪv/
- Kelime başındaki ünsüz kümesi — araya ünlü eklemeyin: stent /stɛnt/, specialty /ˈspɛʃ.əl.ti/, proximal /ˈpɹɒksɪməl/, problematic /ˌpɹɑ.bləˈmæt.ɪk/, flexibility /ˌflɛksɪˈbɪlɪti/
- /æ/ — “e”den daha açık: calcium /ˈkælsi.əm/, diameter /daɪˈæmɪdɚ/, catheter /ˈkæθɪtɚ/, calcify /ˈkælsɪfaɪ/, disadvantage /ˌdɪsədˈvæntɪd͡ʒ/
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; balloon, calcium, millimetre 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.