Pratica di Shadowing: SVINutes: Intracranial Atherosclerotic Disease: Key Considerations for Stenting - Impara a parlare inglese con i video

Caricamento...
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Hello, I am Amir Hassan, and on Zvinitz today we will be talking about intracranial atherosclerotic disease, key considerations for stenting.
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ICAT is a significant cause of ischemic stroke, responsible for 10% of ischemic strokes in the US and up to 50% in Asia.
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In South Texas, we have a 20-30% incidence.
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The disease process, you have a lot of plaque buildup, which leads to stenosis, increasing stroke risk.
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The key stroke mechanisms include hemodynamic compromise, artery embolism, in-situ thrombosis, and perforator strokes.
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Current treatment approaches include medical management with anticoagulants, antiplatelets, and or statin therapy.
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Interventions that include stenting and angioplasty.
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On cases with hemodynamic compromise, stenting has significant superiority over medical therapy.
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In a patient with a basilar stenosis, as you see here on the CT correlating CT perfusion, would benefit this patient much more than medical therapy.
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Versus a perforator stroke alone, as you can see here, this patient would do much better with medical therapy than intracranial stenting.
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Quick overview of the Sampras trial.
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There was a significant risk of instant stenosis.
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There was a significant risk of ischemic strokes
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and what you had was the medical management arm doing significantly better than the intervention arm
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and the trial was prematurely terminated then fast forward several years
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and we have the weave trial
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and the weave trial results were published in stroke in april 2019
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and the main findings were
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if you stuck to the on-label primary analysis findings you had a 2.6 percent event rate of stroke
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or death within 72 hours versus
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if you were off-label those patients were collected in a registry
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and they had up to 23.9 percent risk of stroke or death within 72 hours.
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One of the lessons learned were adjacent perforators.
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You had to undersize the balloon in those lesions and your goal was 60 to 80 percent true lumen diameter.
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Also experience mattered.
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In studies where the enrollment sites had the experience of treating three cases or on on average 10 cases like in Sampras, you had a much higher event rate.
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Whereas in Weave, the average interventionist had placed 37 wingspan stents prior to enrollment.
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Those who had high experience, greater than 50 wingspan stents prior to their first patient enrollment in Weave had a 0% event rate.
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We have several studies that looked at our initial experience with the Resolute Onyx stent, balloon-mounted stent that is drug-coded, and then we looked at 30-day outcomes,
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comparing them to the Sampras medical arm patients with propensity score matching, and we had a multi-center study that included other balloon-mounted stents.
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And what we found was that most of these patients did significantly better if you were on label, meaning you had to treat the patient and wait for seven days,
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maximize medical management with dual anti-plitotherapy and statin therapy, and And we also found significant decreased restenosis rates,
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long-term restenosis, compared to the Wingspan study.
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And here are the publications so you can look at them yourselves.
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The main points here are your tips and your setup for support based on our experience.
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And a key point here is patient selection.
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Patients with severe tortuosity, type 3 arches, an M for a carotid artery,
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common carotid, those cases probably be much more aggressive with your medical therapy before approaching stenting.
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In patients that you do select for stenting, we are very aggressive with P2Y12 testing on all patients.
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If that P2Y12 number is greater than 200, switch the patients to Berlinta 90mg BID.
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My partner does use 60mg BID and we have not found a significant difference between my patients and his patients.
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We always use a bolt ballast or a BMX guide catheter.
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We find that's much more supportive.
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If treating anterior circulation, you will have a lot of difficulty with the radial approach, so we primarily prefer femoral access.
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If you're treating lesions proximal to the periclinoid segment of the carotid, Navian 058-115 is the most supportive DAC.
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If you're treating an MCA lesion, it doesn't cross the periclinoid ophthalmic segments, so a Cat5 or Sophia EX 115 cm is the preferred distal axis catheter.
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We always use Zoom 14 support wire, that is our preferred O14 wire, Synchro 2 support if you don't have the Zoom 14,
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or you can use the Aristotle 14 support wire.
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Regular Synchro 2 and Traxxas just don't have enough support.
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We highly recommend the Resolute Onyx 2x8 mm device because it can comfortably increase in size to about 3.25 with post-dilatation.
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And for all our MCA M1 lesions and our mid-bazilar lesions,
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your perforator-rich teratoids, I don't care if your MCA or your basilar already measures 3-3.5mm, we always use our Resolute Onyx 2x8.
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Thank you very much and have a great day.

Contesto e sfondo

Il video presenta un discorso tecnico su una patologia medica, con un linguaggio specifico e una velocità fluida. Questo tipo di contenuto è ottimo per esercitare l'ascolto di inglese specialistico, ma anche per migliorare la pronuncia e l'intonazione attraverso la tecnica del shadowing in inglese. Il speaker usa frasi complesse, ma con una struttura logica che facilita il follow-up, ideale per chi vuole approfondire la shadow speak.

5 frasi chiave per la comunicazione quotidiana

  • "Key considerations for stenting" – Esempio di frase tecnica che mostra l'uso di "key" per enfatizzare importanza.
  • "Current treatment approaches include" – Struttura base per elencare soluzioni, utile in contesti professionali.
  • "One of the lessons learned were" – Modo per condividere insegnamenti, comune in discussioni informative.
  • "We highly recommend" – Espressione per dare consigli, fondamentale nella comunicazione diretta.
  • "The main points here are" – Frase per riassumere, essenziale per chi vuole organizzare le idee.

Guida passo passo al shadowing per questo video

Per sfruttare al massimo questo video con il shadow speech, segui questi passaggi. Prima, ascolta il video una volta per capire il contesto generale. Poi, riproduci un frammento di 5-10 secondi e ripete immediatamente dopo il speaker, cercando di imitare la sua velocità e l'intonazione: questo è il shadowspeaks nel suo modo più puro. Concentrati sulle parole tecniche, come "stenosis" o "stenting", e nota come vengono pronunciate. Ripeti il processo per ogni sezione, aumentando gradualmente la lunghezza dei frammenti. Infine, registra te stesso e confronta con il video: noterai come migliorare la fluidità. Imparare l'inglese con i video è un modo efficace per unire ascolto e parlato, e questo contenuto tecnico ti aiuterà a rafforzare la capacità di seguire discussioni complesse.

Cos'è la tecnica dello Shadowing?

Shadowing è una tecnica di apprendimento delle lingue supportata da studi scientifici, originariamente sviluppata per la formazione dei traduttori professionisti e resa popolare dal poliglotta Dr. Alexander Arguelles. Il metodo è semplice ma potente: ascolti un audio in inglese di madrelingua e lo ripeti immediatamente ad alta voce — come un'ombra che segue il parlante con un ritardo di solo 1–2 secondi. A differenza dell'ascolto passivo o degli esercizi di grammatica, lo shadowing costringe il tuo cervello e i muscoli della bocca a elaborare e riprodurre simultaneamente i modelli di discorso reale. La ricerca dimostra che migliora significativamente la precisione della pronuncia, l'intonazione, il ritmo, il discorso connesso, la comprensione dell'ascolto e la fluidità del parlato — rendendolo uno dei metodi più efficaci per la preparazione alla prova di speaking dell'IELTS e per la comunicazione reale in inglese.