跟读练习: Decision-making in complex aneurysms: Guilherme Dabus on tools, techniques and safe strategy - 通过YouTube学习英语口语

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Dr. Davos, thank you to be here sharing with us all your knowledge with the faculty,
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Dr. Davos, thank you to be here sharing with us all your knowledge with the faculty,
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giving solutions for the treatment of complex cases,
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how to use the different tools in the management of complex cases.
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So how do you think about the evolution of the newest tools and techniques for treating complex cases?
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I mean, I think, you know,
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if you think about their field for the last 30 years,
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I mean, I've been in practice for almost 20 years,
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and you see the evolution just doesn't stop,
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which is a great thing.
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I mean, you see the device that we have now to treat,
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for example, brain aneurysms or acute stroke from large vasococlusions,
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and also like other areas like the liquid embolix carotid stents
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which also has evolved i mean it's it's just has been an unbelievable journey
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and i think it's been great
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because it really is benefiting the patients i mean it makes our life easier too you know
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which is great but in
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that you know we need to always to think about what is being the best for the patient
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and i think these new tools are really increasing the chance of those patients having a good outcome
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which in the end it's really what we care for.
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Yes.
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How do you feel about the...
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or what do you think about the.. using flower diverters in bifurcation aneurysms?
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Also, as a young neurosurgeon,
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I am afraid about that.
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Yeah, I mean, I think that's still a topic of debate.
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We don't have a clear answer for that.
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I think the most important thing,
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and I tell this to my fellows,
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and I think when I have conferences like this where there's people that have not had a lot of experience yet,
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right like we had it's important to understand that those are tools
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and again you need to look into the aneurysm
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and understand what is going to be the best tool to treat the aneurysm what
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so what's going to be the most effications or effective tool to treat
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that aneurysm in a ratio
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that is also like the safest procedure for the device right for
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that patient right so i think that's the important thing
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that we need to always think about there is a bifurcation aneurysm are are there potentially other options?
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Yeah.
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I mean, is this patient young?
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Is this patient someone that can benefit from other endovascular or even surgical strategy?
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Or there's no other option,
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and maybe putting in flow diverter is the best option.
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We don't have a lot of the clear answer for that.
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I mean, I think we may have some better idea with some further on studies looking to specifically flow diverter into bifurcation,
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but at this point, we don't have actually that answer.
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So I think we need to see those as tools
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that could be used to improve the patient outcome to treat the aneurysm.
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But we don't have the clear answer for that,
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so we need to understand where all the tools are,
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all the possible strategies, and really decide what's going to be the best for that patient.
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So in the case that you are using the cloud diverters in bifurcations,
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what do you think are the key points to avoid the thrombosis of the side branch?
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Yeah, I think, you know,
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again, first of all, you need to see if that's the best strategy for that patient.
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In our practice, we try to refrain from that.
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So we do maybe a stent assisted co-embolization.
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Now, if you can't because of whatever,
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it's a fusiform aneurysm that may be better suited for a flutiver,
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then we would do it.
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And basically in terms like,
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you know,
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side branches usually in our experience what we can do is
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increase a little bit the blood pressure make sure they remain
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patent we usually do delayed angiogram after the flow diver display to make sure
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that branch is still feeling in a normal time
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if not you can use you know different strategies you can give uh glucopoing 2b3 inhibitors for example you know
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that can improve because could be a clot
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that is forming the surface of the stent
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so there are things you can do also like try to put your flow diver on the dominant branch of
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that bifurcation right so you decrease the risk of of having like an important schemic symptom.
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So I think those are important things.
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But again, I guess the key message here is that understanding the bifurcation endos,
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see if there's other possible alternatives to that.
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And if they're not, because of fusiform and you think the flow divert is the best treatment,
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make sure you have a good execution of that
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and make sure you do maybe a 15 minute delayed angiogram
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to make sure the flow is completely along on to the side branches.
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I think that's very helpful.
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Okay.
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So, there were any particular case that you consider particularly educational for young neurosurgeons?
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I think, you know, to be quite honest,
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all the cases are very educational.
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Even for people to understand that maybe
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that should not be what they should try if they're not experienced with a specific device.
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Some of the cases here are difficult and some of the cases are done with people that have a really,
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like, probably some of the maximal level of expertise with a certain device.
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So I think it's very important the person needs to see,
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okay, what is my limitation to do a case like this?
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There are other strategies.
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There's always other strategies.
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So I think if you look into all the kids that were presented,
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I think that's a key lesson to be learned.
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You know, understand what's your strengths and what can you do that actually will help the patient achieve a good outcome.
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But understanding that you have limitations and if you don't have a great expertise of specific device,
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you shouldn't try them difficult case.
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Okay.
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And what's your opinion about the Latin American community in this meeting?
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I mean, the Latin community,
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like when you have like Link Americas, is always great.
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There's always a lot of people from Central and South America.
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There's a lot of people that come from the meeting that live in the U.S and practice here who are,
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you know, South American or Central American.
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So I think that's really enriches a lot like the discussion.
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I think we have different realities that we all learn to live with.
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And, you know, it's great to have discussions and debate about those cases.
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And if you look into the cases and the case that people present,
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I mean, you know, great work is done all over the world.
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So I think that's important that we recognize that as well.
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Yes.
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Thank you, Dr. Davos, to be here.
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You're very welcome.
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My pleasure.
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Thank you very much.

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