跟读练习: Carotid Artery Stenting - Tips & Tricks - 通过YouTube学习英语口语
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In this video, we will discuss challenges and difficulty we faced during one of our carotid artery stenting case.
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In this video, we will discuss challenges and difficulty we faced during one of our carotid artery stenting case.
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Patient is 58 year male,
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presented with acute onset of mild weakness of left upper and lower limb.
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He has many risk factors responsible for atherosclerosis like hypertension,
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hypercholestremia, diabetes and he is a chronic smoker.
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MRI brain showed abnormal T2 hyperintensity at coronary later displaying diffusion restriction suggestive of acute infarct.
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This location of infarct suggests deep watershed territory infarct between the perforator arteries and superficial cortical arteries.
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Right carotid angiography showed near total occlusion of right internal carotid artery with poor intracranial flow
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and there is retrograde reformation of the ophthalmic artery via middle meningeal artery collaterals.
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This angiographic findings suggest hemodynamic compromise of right cerebral hemisphere.
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So we plan for carotid artery stenting under embolic protection device in this case.
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The procedure could be divided into following steps.
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Carotid access, measurement and choosing the appropriate carotid stent and filter size,
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pre-dilatation, embolic filter device deployment, stent deployment and post-dilatation.
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These are the hardware we used in this case.
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Safe carotid access is the first step of carotid artery stenting procedure.
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Always look for unfavorable arch in CT angiography images.
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We placed 8F short sheet at groin and taken 6F long sheet over diagnostic catheter under fluoroscopy to right common carotid artery.
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By this technique we could avoid the exchange maneuver.
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This is the right common carotid artery injection via long sheet.
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We obtained measurement.
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Based on our measurement we choose 6 to 8 millimeter tapered stent from abort
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and we also use a smaller size of available embossed shield.
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As the stenosis is very tight
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and crossing profile of filter device is larger we plan to pre-dialect the stenosis using the coronary balloon.
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We use 1.4 BMW coronary wire and 2.5 mm size of the coronary balloon to dilate the stenosis.
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There is significant improvement of the lumen after the angioplasty.
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Now we cross the lesion using O.1.4 bare wire of the filter device.
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It has a 3 cm distal radio opaque tip which we kept at C1 vertebral level.
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Now AmboShield filter device is taken over the O14 wire.
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Filter is deployed at C2 vertebral level.
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Filter device should be placed in the straight segment of the carotid artery
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and should be more than 2 cm distal to the distal landing zone of carotid stent.
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Filter has migrated proximally to the level of stenosis during removal of its delivery catheter.
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To understand proximal migration of the filter device,
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we need to know the filter design.
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Ambushil filter device has umbrella like nylon membrane and nitinol frame.
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This nylon membrane has multiple micropores to allow the blood perfusion and to trap the embolic material.
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It has two radiopic markers at the proximal and the distal end.
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AmboShield filter device is a monoreal system pre-loaded on O14 wire.
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AmboShield is not fixed on this wire,
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it is freely movable on this wire and because of this there is a risk of intracranial dislodgement of this filter device.
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To avoid any intracranial migration of AmboShield filter device,
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there is a focal step design on the bare wire distal to the filter.
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This focal step is 019 and which will act as a distal limit of the filter device.
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So when this distal 019 step at the bare wire is in contact with the distal marker of the filter device,
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it might drag filter proximally
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if the bare wire is pulled by mistake during the exchange maneuver and this is exactly what had happened in this case.
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We gently push the filter device upward using the retrieval catheter.
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Now stent delivery catheter was taken over O14 bare wire.
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Distal nose of the stent delivery catheter has further pushed the filter device to the desired location.
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Precise location of stent was confirmed by guide catheter injection.
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was deployed and delivery catheter was removed.
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Check angiography showed residual waste so we performed angioplasty of the residual stenosis using 4.5 mm coronary balloon.
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Only after angioplasty, there was complete occlusion of internal carotid artery.
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The possibilities could be that the filter device might have occluded due to the trapped embolic materials
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or acute distant thrombosis or carotid artery dissection and vasospasm.
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We immediately checked ACT which was within desired level.
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We repeated 1000 units of heparin bolus.
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We gave loading dose of agrastat via guide catheter and started IV infusion.
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We also performed aspiration of the thrombus using coronary aspiration catheter.
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After all these efforts, check angiography showed some restoration of the flow in the internal cuted artery and across the filter.
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So we decided to retrieve the filter device.
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While retrieving the filter device,
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we only partially engaged the portion of the filter device inside the retrieval catheter to prevent escape of any trapped emboli.
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After removing the filter device,
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complete flow is restored in the internal carotid artery and the stent.
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Gross examination of the filter device showed trapped embolic materials.
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So we could conclude
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that the sudden occlusion of the carotid artery after balloon angioplasty
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is most likely due to release of lot of embolic materials
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which were trapped by the filter device and causing the complete flow arrest across the carotid artery.
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Once we remove this filter device the flow is restored.
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Final angiogram showed complete revascularization of the internal carotid artery and good restoration of the intracranial circulation.
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This also imply the importance of use of filter device during carotid artery stenting procedure.
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在本课程中，学习者将练习与颈动脉支架置入相关的专业英语词汇和短语。通过观看医疗视频学习内容，您将能够提高自己的英语口语能力，尤其是在医学和健康话题上。同时，通过理解病历的描述，增强对医学英语的理解，适合希望提高英语发音的学习者。无论您是在日常交流中应用，还是希望在专业场合使用英语，本课程都将助您一臂之力。
关键词汇与常用短语
- 颈动脉支架 - Carotid artery stenting
- 动脉内血栓 - Embolic material
- 血流动力学 - Hemodynamic compromise
- 临床表现 - Acute onset of weakness
- CT血管造影 - CT angiography
- 过滤装置 - Filter device
- 冠状动脉 - Coronary artery
- 血管内治疗 - Endovascular procedure
练习技巧
为了在学习中取得最佳效果，您可以尝试阴影练习（shadowing）。随着视频的播放，逐渐跟随语速模仿发音和语调。建议从较慢的速度开始，确保能够准确跟上，然后逐步适应更快的语调。可以选择分段方式，先重复短句，再逐渐延长至完整段落。通过反复练习，您将能够提升自己的英语口语练习技能，特别是在医疗领域。同时，结合看YouTube学英语的方式，提高您对专业术语的发音和运用。确保在学习中关注重音和节奏，以便达到更自然的发音效果。此外，使用shadowspeaks的技巧，帮助您在强化发音的同时，提升对整个句子的流畅度。
什么是跟读法？
跟读法 (Shadowing) 是一种有科学依据的语言学习技巧，最初开发用于专业口译员的培训，并由多语言者Alexander Arguelles博士普及。这个方法简单而强大：您在听英语母语原声的同时立即大声重复——就像是一个延迟1-2秒紧跟说话者的影子。与被动听力或语法练习不同，跟读法强迫您的大脑和口腔肌肉同时处理并模仿真实的讲话模式。研究表明它能显着提高发音准确性，语调，节奏，连读，听力理解和口语流利度——使其成为雅思口语备考和真实英语交流最有效的方法之一。