Intraoperative Assessment of the Axial Rotational Positioning of a Modern Ankle Arthroplasty Tibial Component Using Preoperative Patient-Specific Instrumentation Guidance

Background: The use of patient-specific instrumentation (PSI) in modern total ankle replacement (TAR) has augmented positioning of the tibial component, eliminating the need for complex jigs. Coronal and sagittal alignment are intuitive with this design and have been studied, but axial rotation has not. The purpose of this study was to assess the relationship between the planned preoperative axial rotation as set by the PSI guide and the rotation determined intraoperatively with non-PSI instrumentation. Methods: This was a prospective cohort study of 22 consecutive cases. The axial rotation angle between the medial gutter and the tibial implant position on the preoperative CT-scan based plan was extracted. At the time of surgery, the medial gutter alignment instrument from the non-PSI instrumentation was inserted and an intraoperative axial photograph obtained to record the angle between the medial gutter and the axial rotation guide pins set by the PSI instrumentation. The 2 measurements were compared and further statistical analysis included Pearson correlation and paired Student t test. Results: The average axial rotation angle between the medial gutter and the implant on the PSI preoperative plan was 5.4 ± 2.9 degrees, whereas the intraoperative photograph from the medial gutter alignment instrument to the pin was 5.9 ±3.8 degrees. This demonstrated a Pearson correlation of R = 0.54 and a P value of .53. The average difference between the two was −0.46 (95% CI: –2.04, 1.10), meaning that components were either slightly externally rotated or that the fork was aimed internally. Based on this group, 50% (11/22) were within 2 degrees of the target and 77% (17/22) were within 4 degrees of the target. Conclusion: Patient-specific guides allowed for reproducible rotational tibial component implantation in modern TAR. Further work is needed to better understand the biomechanical effects of the rotational profile and consequences on survivorship. Level of Evidence: Level IV, case series.

Download Full-text

Role of Rotation in Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100719867068 ◽

2019 ◽

Vol 40 (12) ◽

pp. 1358-1367 ◽

Cited By ~ 5

Author(s):

Ali-Asgar Najefi ◽

Yaser Ghani ◽

Andy Goldberg

Keyword(s):

Pearson Correlation ◽

Axial Rotation ◽

Total Ankle Replacement ◽

Ct Scans ◽

Tibial Torsion ◽

Level Of Evidence ◽

Ankle Replacement ◽

Preoperative Ct ◽

The Mean ◽

Foot Position

Background: The importance of total ankle replacement (TAR) implant orientation in the axial plane is poorly understood with major variation in surgical technique of implants on the market. Our aim was to better understand the axial rotational profile of patients undergoing TAR. Methods: In 157 standardized computed tomography (CT) scans of patients with end-stage ankle arthritis planning to undergo primary TAR surgery, we measured the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA), and the tibiotalar angle. The foot position was measured in relation to the TMA with the foot plantigrade. The variation between the medial gutter line and the line bisecting both gutters was assessed. Results: The mean external tibial torsion was 34.5 ± 10.3 degrees (11.8-62 degrees). When plantigrade, the mean foot position relative to the TMA was 21 ± 10.6 degrees (0.7-38.4 degrees) internally rotated. As external tibial torsion increased, the foot position became more internally rotated relative to the TMA (Pearson correlation, 0.6; P < .0001). As the tibiotalar angle became more valgus, the foot became more externally rotated relative to the TMA (Pearson correlation, −0.4; P < .01). The mean difference between the medial gutter line and a line bisecting both gutters was 4.9 ± 2.8 degrees (1.7-9.4 degrees). More than 51% of patients had a difference greater than 5 degrees. The mean angle between the medial gutter line and a line perpendicular to the TMA was 7.5 ± 2.6 degrees (2.8-13.7 degrees). Conclusion: There was a large variation in rotational profile of patients undergoing TAR, particularly between the medial gutter line and the TMA. Surgeon designers and implant manufacturers should develop consistent methods to guide surgeons toward judging the appropriate axial rotation of their implant on an individual basis. We recommend careful clinical assessment and preoperative CT scans to enable the correct rotation to be determined. Level of Evidence: Level IIc, outcomes research.

Download Full-text

An Intra-Operative Assessment of the Axial Rotational Positioning of the Tibial Component Using Patient-Specific Instrumentation Prophecy

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00180 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0018

Author(s):

Oliver J. Gagne ◽

Andrea Veljkovic ◽

Dave Townshend ◽

Alastair S.E. Younger ◽

Kevin J. Wing ◽

...

Keyword(s):

Tibial Component ◽

External Rotation ◽

Cohort Analysis ◽

Axial Rotation ◽

Patient Specific ◽

Good Representation ◽

Rotational Angle ◽

Patient Specific Instrumentation ◽

Student’S T ◽

Operative Assessment

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle replacements (TAR) have evolved significantly over the past 10 years. While most TAR systems reference the medial gutter to set axial tibial component rotation, newer CT scan-based patient specific instrumentation (PSI) allows any rotational position to be set, and this is commonly set to bisect the medial and lateral gutter lines. It is still not yet known which alignment technique is optimal. Methods: We initiated a prospective cohort analysis of 22 consecutive cases using the Prophecy® 3D PSI guide (Wright Medical Technologies, Memphis, TN). There were four foot and ankle fellowship trained surgeons practicing from two referral centers. Every procedure had an intra-operative photograph taken from the knee looking down to the ankle after both the attachment of the PSI guide to the tibia and the insertion of the standard medial gutter fork. The axial rotational angle between both was measured and compared to the Prophecy® pre-operative plan. Statistical analysis was performed using the student’s T-test for paired distribution and descriptive statistics given the number of cases (N=22). Results: The primary outcome of this study was to assess the correlation between the pre-operative medial gutter line drawn on the Prophecy plan and the intra-operative medial gutter fork angle. The Pearson R correlation value was 0.54 (p = 0.53). The average difference between the pre-operative medial gutter line on the Prophecy® plan and the intra-operative gutter fork was -0.46 [95% CI -2.04 – 1.10]. This could mean that the medial gutter fork is on average slightly more internally rotated than templated medial gutter line. However, the average of the absolute differences between the preoperative medial gutter line and the intraoperative medial gutter fork was 2.69 degrees. Of the 22 cases, 11 were within 2 degrees and 17 were within 4 degrees. Conclusion: The medial gutter line on Prophecy® PSI pre-operative TAR plans is a moderately good representation of the intra- operative medial gutter fork position used in standard TAR instrumentation. Based on this, using the Prophecy® default which sets the tibial implant axial rotation to bisect the medial and lateral gutter lines will typically lead to greater external rotation of the tibial component compared to standard TAR instrumentation which aligns the tibial component to the medial gutter fork. Further work needs to be done to better understand which of these axial alignment options, or potentially others, is optimal.

Download Full-text

Accuracy of CT-Derived Patient-Specific Instrumentation for Total Ankle Arthroplasty: The Impact of the Severity of Preoperative Varus Ankle Deformity

Foot & Ankle Specialist ◽

10.1177/19386400211068262 ◽

2022 ◽

pp. 193864002110682

Author(s):

Benjamin D. Umbel ◽

Taylor Hockman ◽

Devon Myers ◽

B. Dale Sharpe ◽

Gregory C. Berlet

Keyword(s):

Case Series ◽

Varus Deformity ◽

Total Ankle Arthroplasty ◽

Patient Specific ◽

Level Of Evidence ◽

Neutral Group ◽

Ankle Arthroplasty ◽

Patient Specific Instrumentation ◽

Implant Alignment ◽

The Impact

Background Significant preoperative varus tibiotalar deformity was once believed to be a contraindication for total ankle arthroplasty (TAA). Our primary goal was to evaluate the influence of increasing preoperative varus tibiotalar deformity on the accuracy of final implant positioning using computed tomography (CT)-derived patient-specific guides for TAA. Methods Thirty-two patients with varus ankle arthritis underwent TAA using CT-derived patient-specific guides. Patients were subcategorized into varying degrees of deformity based on preoperative tibiotalar angles (0°-5° neutral, 6°-10° mild, 11°-15° moderate, and >15° severe). Postoperative weightbearing radiographs were used to measure coronal plane alignment of the tibial implant relative to the target axis determined by the preoperative CT template. Average follow-up at the time of data collection was 36.8 months. Results Average preoperative varus deformity was 6.06° (range: 0.66°-16.3°). Postoperatively, 96.9% (30/31) of patients demonstrated neutral implant alignment. Average postoperative tibial implant deviation was 1.54° (range: 0.17°-5.7°). Average coronal deviation relative to the target axis was 1.61° for the neutral group, 1.78° for the mild group, 0.94° for the moderate group, and 1.41° for the severe group (P = .256). Preoperative plans predicted 100% of tibial and talar implant sizes correctly within 1 size of actual implant size. Conclusion. Our study supports the claim that neutral postoperative TAA alignment can be obtained using CT-derived patient-specific instrumentation (PSI). Furthermore, final implant alignment accuracy with PSI does not appear to be impacted by worsening preoperative varus deformity. All but one patient (96.9%) achieved neutral postoperative alignment relative to the predicted target axis. Level of Evidence: Level IV, Clinical Case Series

Download Full-text

Functional assessment of foot and ankle tendinopathies treated with tendoscopy

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1531 ◽

2021 ◽

Vol 15 (2) ◽

pp. 128-132

Author(s):

Rodrigo Guimarães Huyer ◽

Mário Sérgio Paulillo Cillo ◽

Carlos Daniel Cândido Castro Filho ◽

Hallan Douglas Bertelli ◽

Renato Morelli Berg

Keyword(s):

Functional Assessment ◽

Descriptive Analysis ◽

Case Series ◽

P Value ◽

Peroneal Tendon ◽

Foot And Ankle ◽

Treatment Results ◽

Duration Of Treatment ◽

Aofas Score ◽

Level Of Evidence

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot & Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was <0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

Download Full-text

Comparison of Time and Cost Savings Using Different Cost Methodologies for Patient-Specific Instrumentation vs Standard Referencing in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419884278 ◽

2019 ◽

Vol 4 (4) ◽

pp. 247301141988427

Author(s):

Ian Savage-Elliott ◽

Victor J. Wu ◽

Isabella Wu ◽

John Timothy Heffernan ◽

Ramon Rodriguez

Keyword(s):

Intraclass Correlation ◽

Cost Savings ◽

Patient Specific ◽

Fixed Cost ◽

Level Of Evidence ◽

Tourniquet Time ◽

Radiographic Outcomes ◽

Patient Specific Instrumentation ◽

Implant Size ◽

The Cost

Background: Patient-specific 3-D printing cutting blocks (PSI) have been used instead of traditional intramedullary cutting guides. We hypothesized that PSI would lead to significantly decreased operating room (OR) time and significant cost savings to our institution with noninferior radiographic outcomes and no difference in expected vs actual implant size when compared with standard referencing (SR). Methods: Patients who had undergone total ankle replacements at our institution from 2013 through 2016 were included in the study. Associations between demographic variables and postoperative alignment in the SR vs PSI group were calculated using the Wilcoxon rank-sum test and the intraclass correlation coefficient. The cost of the operation was calculated using both an institutionally based fixed cost of OR time and using Time Driven Activity Based Cost (TDABC) accounting. A total of 43 patients were included in the study, 13 in the SR group and 30 in the PSI group. Results: Operative time (168 vs 137 minutes) and tourniquet time (123 vs 113 minutes) were significantly lower in the PSI vs the SR group. PSI predictions were accurate 100% of the time for tibial components and 83% of the time for talar components. Average costs of TAA using PSI were significantly reduced by $7597.00 when using traditional OR accounting, whereas PSI was $836.00 more expensive on average using TDABC accounting. Conclusion: Further research is needed to determine the cost-effectiveness of PSI vs SR in TAA; however, it does appear to save time intraoperatively. The long-term effect on clinical outcomes requires further study. Level of Evidence: Level III, case-control study.

Download Full-text

Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100717709566 ◽

2017 ◽

Vol 38 (9) ◽

pp. 952-956 ◽

Cited By ~ 4

Author(s):

Manja Deforth ◽

Nicola Krähenbühl ◽

Lukas Zwicky ◽

Markus Knupp ◽

Beat Hintermann

Keyword(s):

Tibial Component ◽

Corrective Osteotomy ◽

Distal Tibia ◽

Case Series ◽

Outcome Data ◽

Total Ankle Replacement ◽

Level Of Evidence ◽

Supramalleolar Osteotomy ◽

Ankle Replacement ◽

Surface Angle

Background: Persistent pain despite a total ankle replacement is not uncommon. A main source of pain may be an insufficiently balanced ankle. An alternative to the revision of the existing arthroplasty is the use of a corrective osteotomy of the distal tibia, above the stable implant. This strictly extraarticular procedure preserves the integrity of the replaced joint. The aim of this study was to review a series of patients in whom a corrective supramalleolar osteotomy was performed to realign a varus misaligned tibial component in total ankle replacement. We hypothesized that the supramalleolar osteotomy would correct the malpositioned tibial component, resulting in pain relief and improvement of function. Methods: Twenty-two patients (9 male, 13 female; mean age, 62.6 years; range, 44.7-80) were treated with a supramalleolar osteotomy to correct a painful ankle with a varus malpositioned tibial component. Prospectively recorded radiologic and clinical outcome data as well as complications and reoperations were analyzed. Results: The tibial anterior surface angle significantly changed from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively ( P < .0001), the American Orthopaedic Foot & Ankle Society hindfoot score significantly increased from 46 ± 14 to 66 ± 16 points ( P < .0001) and the patient’s pain score measured with the visual analog scale significantly decreased from 5.8 ± 1.9 to 3.3 ± 2.4 ( P < .001). No statistical difference was found in the tibial lateral surface angle and the range of motion of the ankle when comparing the preoperative to the postoperative measurements. The osteotomy healed in all but 3 patients on first attempt. Fifteen patients (68%) were (very) satisfied, 4 moderately satisfied, and 3 patients were not satisfied with the result. Conclusion: The supramalleolar osteotomy was found to be a reliable treatment option for correcting the varus misaligned tibial component in a painful replaced ankle. However, nonunion (14%) should be mentioned as a possible complication of this surgery. Nonetheless, as a strictly extraarticular procedure, it did not compromise function of the previously replaced ankle, and it was shown to relieve pain without having to have revised a well-fixed ankle arthroplasty. Level of evidence: Level IV, case series.

Download Full-text

INFLUENCE OF MAXIMAL ISOMETRIC STRENGTH ON 20-METER SPRINT TIME

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-8692202127012020_0028 ◽

2021 ◽

Vol 27 (1) ◽

pp. 60-64

Author(s):

Álvaro Huerta Ojeda ◽

Daniel Jerez-Mayorga ◽

Sergio Galdames Maliqueo ◽

Darío Martínez García ◽

Ángela Rodríguez-Perea ◽

...

Keyword(s):

Isometric Force ◽

Pearson Correlation ◽

Case Series ◽

Level Of Evidence ◽

Jump Test ◽

Wide Range ◽

Natural Movement ◽

And Performance ◽

High Level ◽

Very High

ABSTRACT Introduction The squat is an exercise that is widely used for the development of strength in sports. However, considering that not all sports gestures are vertical, it is important to investigate the effectiveness of propulsive force stimuli applied in different planes. Objective The main purpose of this study was to determine the influence of maximum isometric force (MIF) exerted on starting blocks over performance in 5, 10 and 20-meter sprints. Methods Seven high-level male sprinters (mean age ± SD = 28 ± 5.77 years) participated in this study. The variables were: a) MIF in squats and on starting blocks (measured using a functional electromechanical dynamometer [FEMD]), b) time in 5, 10 and 20-m sprints and c) jump height (measured by the squat jump test). For data analysis, a Pearson correlation was performed between the different variables. The criteria for interpreting the strength of the r coefficients were as follows: trivial (<0.1), small (0.1−0.3), moderate (0.3−0.5), high (0.5−0.7), very high (0.7−0.9), or practically perfect (>0.9). The level of significance was p < 0.05. Results There was very high correlation between MIF exerted on starting blocks and performance in the first meters of the sprint (5-m: r = -0.84, p = 0.01). However, there was small correlation between MIF in squats and performance in the first meters of the sprint (5-m: r = -0.22, p < 0.62). Conclusion The MIF applied on starting blocks correlates very high with time in the first meters of the sprint in high-level athletes. In addition, the use of the FEMD provides a wide range of possibilities for evaluation and development of strength with a controlled natural movement. Level of evidence IV; Prognostic Studies - Case series.

Download Full-text

Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

Knee Surgery and Related Research ◽

10.1186/s43019-019-0018-y ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Kazumi Goto ◽

Yozo Katsuragawa ◽

Yoshinari Miyamoto

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Operative Time ◽

Case Series ◽

Level Of Evidence ◽

Ankle Angle ◽

Total Knee ◽

The Mean ◽

Hip Knee Ankle Angle

Abstract Purpose There are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes. Materials and methods Nineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip–knee–ankle angle, and femoral and tibial component angle were evaluated. Results The mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2° in group S and 114.2° in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip–knee–ankle angle, femoral component angle, or tibial component angle were observed. Conclusions Although operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed. Level of evidence IV (retrospective case series design).

Download Full-text

Long-Term Results of the Modular Physiological Wrist Prosthesis (MPW®) in Patients with Inflammatory Diseases

Life ◽

10.3390/life11040355 ◽

2021 ◽

Vol 11 (4) ◽

pp. 355

Author(s):

Christoph Biehl ◽

Martin Stoll ◽

Martin Heinrich ◽

Lotta Biehl ◽

Jochen Jung ◽

...

Keyword(s):

Inflammatory Diseases ◽

Case Series ◽

Long Term Results ◽

Patient Specific ◽

Dash Score ◽

Level Of Evidence ◽

Good Pain Relief ◽

Clinical And Radiological Outcome

The wrist is among the predilection sites of over 90% of cases of rheumatoid arthritis (RA). In advanced cases, total wrist arthroplasty (TWA) is an alternative to arthrodesis. The aim of this study is to present the long-term results of the modular physiological wrist prosthesis (MPW®) and to match them in context with the results of a standard population survey. In a retrospective study with follow-up, patients with an MPW® endoprosthesis were evaluated concerning the clinical and radiological outcome, complications were reviewed (incidence and type), and conversion to wrist fusion was assessed. Patient function measurements included the Mayo wrist score, the patient-specific wrist test, and therefore the DASH score (arm, shoulder, and hand). Thirty-four MPW® wrist prostheses were implanted in 32 patients, including thirty primary implantations and four changes of the type of the endoprosthesis. Sixteen patients (18 prostheses) underwent clinical and radiological follow-up. The average follow-up time was 8.5 years (1 to 16). Poor results of the MPW prosthesis are caused by the issues of balancing with luxation and increased PE wear. Salvage procedures included revision of the TWA or fusion. In successful cases, the flexion and extension movement averaged 40 degrees. The grip force was around 2.5 kg. The common DASH score was 79 points, with limited and problematic joints of the upper extremity. The MPW wrist prosthesis offered good pain relief and functional movement in over 80% of cases. The issues of dislocation and increased PE wear prevent better long-term results, as do the joints affected. A follow-up study with fittings under a contemporary anti-rheumatic therapy with biologicals suggests increasing score results. Type of study/level of evidence: Case series, IV.

Download Full-text

Abstract TMP21: Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke in Patients with Thrombocytopenia

Stroke ◽

10.1161/str.48.suppl_1.tmp21 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ashkan Mowla ◽

Haris Kamal ◽

Navdeep Lail ◽

Rick Magun ◽

Sandhya Mehla ◽

...

Keyword(s):

Platelet Count ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Series ◽

Intravenous Thrombolysis ◽

P Value ◽

Class Iii ◽

Exclusion Criteria ◽

Level Of Evidence ◽

Significant Difference

Objective: To evaluate the rate of symptomatic intracranial hemorrhage (sICH) in patients who received Intravenous tPA(IVT) for acute ischemic stroke(AIS) and were later found to have platelets less than 100,000 /mm 3 . Background: With increasing use of IVT for AIS and more studies on its risk and benefits, many of the initial exclusion criteria which were part of the pivotal NINDS trial have been challenged with well-designed case series and reports. Based on the latest scientific statement from the AHA/ASA on the exclusion and inclusion criteria for IVT in AIS published in February 2016, the safety and efficacy of IVT in AIS is unknown for the patients with platelet count <100,000(Class III, Level of evidence C). The platelet threshold of 100,000 /mm 3 was derived from expert consensus in the NINDS trial and since many of the exclusion criteria have been challenged, this value also comes into question. Methods: We retrospectively reviewed the charts of all patients who received IVT for AIS from the beginning of 2006 till the end of August 2015 at our large volume comprehensive stroke center (SUNY Buffalo). Those with platelets <100,000/mm 3 were identified. Head CT done in 24 to 36 hours Post-thrombolysis was reviewed to evaluate the rate of sICH. sICH was defined as ICH with an increase in National Institute of Health Stroke Scale of at least 4 points. Results: A total of 835 patients received IV rtPA for AIS in our center during a 9·6-year period. Fifty one patients (6.1 %) were found to have sICH. A total of 5 patients (0.6 %) were identified to have platelet count <100,000 /mm 3 . One of them (20%) developed sICH post IV tPA administration .The mean platelet count of those 5 patients was 63,000 ± 19,000 /mm 3 (Range: 38,000 - 85,000 /mm 3 ) . To the best of our knowledge, only 21 thrombocytopenic patients have been reported to receive IV rtPA for AIS in the medical literature. Combining our 5 cases with 21 patients previously reported, we have 26 AIS patients who had platelet count <100,000 /mm 3 and received IV rtPA, with 2 of them developed sICH (7.7 %). Comparing the rate of sICH among this group with the patients with normal platelet count in our cohort, there was no statistically significant difference (7.7% versus 6.04%, p-value = 0.73). Conclusion: Although our extremely low number of cases precludes any solid conclusion, IV rtPA for AIS might be safe in patients with platelet count <100,000/ mm 3 and it is reasonable not to delay IV rtPA administration while waiting for the platelet count result, unless there is strong suspicion for abnormal platelet count.

Download Full-text