Overtightening of the Syndesmosis Revisited and the Effect of Syndesmotic Malreduction on Ankle Dorsiflexion

Category: Ankle, Trauma Introduction/Purpose: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior & posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion. Methods: Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior & posterior malreduction of the syndesmosis. Results: Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99). Conclusion: Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.

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A Novel Elastic Wrap for Syndesmotic Reduction with Post-Operative CT Scan Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00374 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0037

Author(s):

Daniel R. Schlatterer ◽

Chet Despande ◽

Aaron Morgenstein

Keyword(s):

Clinical Practice ◽

Ct Scan ◽

Screw Fixation ◽

Ct Scans ◽

Anatomic Reduction ◽

Ankle Trauma ◽

Common Clinical Practice ◽

Ct Scan Analysis ◽

Uniform Reduction

Category: Ankle, Trauma Introduction/Purpose: Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification. Methods: Syndesmosis malreductions occur in up to 50% of patients. Several studies concluded that the position of the reduction tines of the periarticular clamp determines the final fibular position. The purpose of this study was to determine if an elastic wrap would provide a more uniform reduction force resulting in an anatomic syndesmosis reduction. We hypothesized that the force applied to the ankle by an elastic wrap would be relatively low and uniform circumferentially around the ankle medially and laterally. Furthermore we thought the ankle wrap would negate the dependency of clamp tine placement and circumferentialy reduce the syndesmosis perfectly. In this series Syndesmotic injuries were treated with the wrap for reduction, screw fixation and post-operative CT scan verification. Results: In a grossly unstable cadaver ankle model the ankle wrap achieved a perfect reduction every time it was trialed. The pressure film component of this study confirmed a uniform reduction force circumferentially at the ankle under the ankle wrap device of 5-9 pounds per square inch. Post-operative CT scans in 5 cases confirmed anatomic reduction of the syndesmosis in those cases treated surgically with the wrap and screw fixation. Conclusion: Malreduction of the syndesmosis can be avoided by using an elastic wrap instead of the standard peri-articular clamp in common clinical practice today.

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Efficacy of the Glidepath Technique for Ankle Syndesmosis Reduction

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00472 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0047

Author(s):

Alicia M. Unangst ◽

Paul M. Ryan ◽

Mitchell Harris ◽

Daniel Song

Keyword(s):

Screw Fixation ◽

Kirschner Wire ◽

Contralateral Side ◽

Ankle Injuries ◽

Syndesmotic Screw ◽

Improved Outcomes ◽

Axis Parallel ◽

Ankle Trauma ◽

Superior Border ◽

Subjective Outcomes

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic screw fixation is frequently required in rotational ankle injuries. Fibular malreduction after syndesmotic screw fixation occurs in as many as 52% of cases, which has been shown to detrimentally affect subjective outcomes and increase the probability of developing arthritis. The glidepath technique has been proposed as a useful technique to prevent malreduction. We hypothesize that the glidepath technique reduces the occurrence of fibular malreduction and results in improved outcomes compared to clamping. Methods: A retrospective cohort study comparing 25 patients reduced with a clamp compared to 18 patient using the glidepath technique. The glidepath technique, described by Needleman, the fibula is manually reduced and a Kirschner wire is placed through the fibula and tibia along the transmalleolar axis, parallel to the superior border of the ankle mortise. CT scans of the injured and contralateral ankles were obtained postoperatively to assess reduction. Malreduction is defined as >2mm difference between the anterior or posterior incisura-fibular distance of the injured ankle compared to the contralateral side. Prospective outcomes were assessed using the AOFAS and VR-12 scores at preoperative, 3 month, 6 month and 1 year followup of the glidepath cohort only. Results: We found a statistically significant reduction in malreduced syndesmoses using the glidepath technique when compared with the clamping technique. In our study, 17% (3/18) were malreduced using the glidepath technique, compared with 48% (12/25 patients) with clamping (p=0.005). The three malreductions seen in our study were anterior, we had no posterior malreductions. Compared with the clamping cohort that had 10/25 posterior malreductions and 2/25 anterior malreductions. Mean outcomes at 3,6 and 1 year scores were AOFAS 76, 86,86; VR-12 46,53,50/ 42,44,47 (physical/mental) respectively. Conclusion: Historically, malreduction for syndesmotic fixation is as high as 52%. The glidepath technique is a viable reduction maneuver that has lower rates of malreduction compared to clamping in our study. This is the first ever CT confirmed study measuring syndesmosis reduction utilizing manual reduction. The value of this technique is that is does not require an open reduction, arthroscopic visualization/reduction or CT guidance to achieve syndesmotic reduction.

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Suture Button versus Syndesmotic Screw for Syndesmotic Injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00443 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0044

Author(s):

Yoshiharu Shimozono ◽

Eoghan Hurley ◽

John Kennedy

Keyword(s):

Clinical Studies ◽

Screw Fixation ◽

Meta Analysis ◽

Implant Removal ◽

Implant Failure ◽

Athletic Injury ◽

P Value ◽

Suture Button ◽

Syndesmotic Screw ◽

Significant Difference

Category: Trauma Introduction/Purpose: Syndesmotic injuries are a common athletic injury and involved in approximately 13% of ankle fractures. Screw fixation (SS) has been the most common fixation treatment for syndesmotic injury, however syndesmosis malreduction has been reported to occur up to more than 50% in syndesmotic screw fixation. Recently, suture-button fixation (SB) technique has been developed to restore anatomic function of the syndesmosis, with potential advantages of allowing physiological movement of syndesmosis, anatomic healing, avoidance of implant removal and earlier rehabilitation. However, optimal surgical treatment is still controversial to date. The purpose of this study was to compare the clinical outcomes of SB and SS fixation techniques for syndesmotic injuries with a meta-analysis of the clinical studies comparing SB and SS fixation for syndesmosis injuries. Methods: The literature search was performed according to the PRISMA guidelines to identify cohort studies comparing SB and SS fixation for syndesmosis injuries. The level of evidence (LOE) was assessed based on the criteria by the Oxford-Centre for Evidence Based Medicine. Statistical analysis was performed using RevMan, and a p-value of < 0.05 was considered to be statistically significant. Results: Ten clinical studies were identified comparing 222 patients with SB to 235 patients with SS fixation. Patients treated with SB had a higher postoperative AOFAS score at a mean of 17.2 months (90.9 vs 87.3, p = 0.002). SB resulted in a lower rate of implant failure (0.0% vs 27.1%, p < 0.0001), implant removal failure (4.0% vs 37.5%, p < 0.0001), and joint malreduction (0.8% vs 10.7%, p = 0.009). However, there was no significant difference in the rate of other complications with SB (4.2% vs 8.6%, p = 0.21). Conclusion: SB fixation results in improved functional outcomes, lower rates of implant failure, and joint malreduction. Based on the findings of this meta-analysis SB appears to be favorable to SS for treating syndesmotic injuries.

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The Radiologic Change of Distal Tibiofibular Joint Following the Removal of the Transfixing Screw After Syndesmotic Injury

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000052 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Bi O Jeong ◽

Jong Hun Baek ◽

Wookjae Song

Keyword(s):

Screw Fixation ◽

Ct Scans ◽

Syndesmotic Injury ◽

Anatomic Reduction ◽

Syndesmosis Injury ◽

Before And After ◽

Tibiofibular Joint ◽

Ankle Trauma ◽

Axial Ct ◽

Male Patients

Category: Ankle, Trauma Introduction/Purpose: Transfixing screw fixation is required after anatomic reduction of syndesmosis disruption. An accurate anatomic reduction is related to good functional outcome. However, there is a dispute over whether the transfixing screw should be removed, and little is known about the change of syndesmosis integrity after screw removal. This study aimed to evaluate the effect of transfixing screw removal on syndesmosis integrity with computed tomography (CT) scans. Methods: The study was done prospectively on 28 cases (28 patients) who had transfixing screw fixation for syndesmosis injury from September 2010 to August 2016. Mean age was 31.9 years (range, 17 to 55 years). There were 20 male patients and 8 female patients. Transfixing screws were removed after 3 months, and CT scans were done just before and 3 months after transfixing screw removal. Anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT images for radiological analysis of changes in syndesmosis integrity between before and after screw removal. Results: Malreduction was observed in 7 cases (25%) before transfixing screw removal. All 7 cases were anterior malreductions. Syndesmosis was spontaneously reduced after screw removal in 5 out of the 7 malreduction cases (71.4%). The A/P ratio in the 7 cases decreased from average 1.37 (range, 1.25 to 1.61) before screw removal to average 1.12 (range, 0.96 to 1.25) after screw removal. The decrease was statistically significant (p = 0.016). Syndesmosis malreduction rate decreased from 25% before screw removal to 7.1% after screw removal. All patients with adequate reduction of their syndesmosis continued to have a reduced syndesmosis after transfixing screw removal. However, this difference in malreduction rate was statistically insignificant (p=0.063). Conclusion: Although the malreduction rate is relatively high after transfixing screw fixation in disrupted syndesmosis, the malreduced syndesmosis was spontaneously reduced in 71% of cases after screw removal. Therefore, it is beneficial to remove the transfixing screw a certain period of time after transfixing screw fixation to achieve anatomic reduction of the syndesmosis.

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Effect of Ankle Position on Tibiotalar Motion With Screw Fixation of the Distal Tibiofibular Syndesmosis in a Fracture Model

Foot & Ankle International ◽

10.1177/1071100718759966 ◽

2018 ◽

Vol 39 (6) ◽

pp. 746-750 ◽

Cited By ~ 5

Author(s):

Mark P. Pallis ◽

David N. Pressman ◽

Kenneth Heida ◽

Tyler Nicholson ◽

Susan Ishikawa

Keyword(s):

Screw Fixation ◽

External Rotation ◽

Fracture Model ◽

Tibiofibular Syndesmosis ◽

Traumatic Injuries ◽

Lag Screw ◽

Syndesmotic Screw ◽

Distal Tibiofibular Syndesmosis ◽

Anatomic Reduction ◽

Pronation External Rotation

Background: Anatomic reduction and fixation of the syndesmosis in traumatic injuries is paramount in restoring function of the tibiotalar joint. While overcompression is a potential error, recent work has called into question whether ankle position during fixation really matters in this regard. Our study aimed to corroborate more recent findings using a fracture model that, to our knowledge, has not been previously tested. Methods: Twenty cadaver leg specimens were obtained and prepared. Each was tested for tibiotalar motion under various conditions: intact syndesmosis, intact syndesmosis with lag screw compression, pronation external rotation type 4 (PER-4) ankle fracture with syndesmotic disruption, and single-screw syndesmotic fixation followed by plate and screw fracture and syndesmotic screw fixation. In each situation, the ankle was held in alternating plantarflexion and dorsiflexion when inserting the syndesmotic screw with the subsequent amount of maximal dorsiflexion being recorded following hand-tight lag screw fixation. Results: While ankle range of motion increased significantly with creation of the PER-4 injury, under no condition was there a statistically significant change in maximal dorsiflexion angle. Conclusion: Ankle position during distal tibiofibular syndesmosis fixation did not limit dorsiflexion of the ankle joint. Clinical Relevance: Our findings suggest that maximal dorsiflexion during syndesmotic screw fixation may not be necessary.

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SERUM PROLACTINE LEVEL IN PATIENTS OF PSORIASIS VULGARIS AND ITS CORRELATION WITH DISEASE SEVERITY: A CASE-CONTROL STUDY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.303 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Pawan Kumar Saini ◽

Devendra Yadav ◽

Rozy Badyal ◽

Suresh Jain ◽

Arti Singh ◽

...

Keyword(s):

Disease Severity ◽

Prolactin Level ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Serum Prolactin ◽

P Value ◽

Serum Prolactin Level ◽

R Value ◽

Control Study

Background: Psoriasis is an autoimmune chronic inflammatory disorder affecting the skin mediated by T-lymphocytes resulting in production of cytokines which cause hyperproliferation of keratinocytes. Several factors and hormones like Prolactin have an action similar to these cytokines in promoting the multiplication of keratinocytes and other cells like lymphocytes and epithelial cells may have a role on the etiopathogenesis of psoriasis. Aim:-The aim of study is to compare the serum Prolactin levels in patients of psoriasis with a control group. Setting and study design: This is a case-control study conducted in the department of Dermatology, Venereology and Leprosy GMC, Kota over a period of 1year from July 2017 to June 2018 Material and method: The study included 100 cases of psoriasis (60 males and 40 females) and 100 controls similar for age and sex. Serum Prolactin levels were measured by ECLIA and results were obtained. Statistical analysis: Mean and standard deviation were calculated for each variable. Statistical significance of the results was analyzed using correlation analysis (Pearson correlation coefficient) and independent samples t-test. Statistical significance was assumed at p value<0.05. Result: Serum Prolactin level was significantly higher in cases of psoriasis compared to controls (p-value <0.001). PASI score and serum Prolactin levels were found to have a positive correlation (r value = 0.337; p-value: 0.001). No significant correlation was found between serum levels of Prolactin and duration of disease r value= -0.034, P value =0.733). Serum Prolactin level was higher in male patients compared to females patients. Conclusion:- High serum Prolactin may be a biological marker of disease severity in psoriasis and may have a role in the pathogenesis of psoriasis. Further studies with large sample size are required to confirm this hypothesis.

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Efektifitas Ekstrak Daun Sirih Hijau (Piper Betle) sebagai Insektisida Nabati terhadap Mortalitas Lalat Rumah (Musca domestica)

Jurnal Kesehatan Terpadu (Integrated Health Journal) ◽

10.32695/jkt.v10i2.42 ◽

2019 ◽

Vol 10 (2) ◽

pp. 44-50

Author(s):

Rinaldi Daswito ◽

Rima Folentia ◽

M Yusuf MF

Keyword(s):

Musca Domestica ◽

Leaf Extract ◽

Effective Concentration ◽

P Value ◽

Piper Betle ◽

Microbiology Laboratory ◽

House Flies ◽

Betel Leaf ◽

The One ◽

One Way Anova

One of the diseases that can be transmitted by flies is diarrhea. Green betel leaf contains essential oils, chavicol, arecoline, phenol, and tannins which function as plant-based insecticides. This study aimed to determine the effectiveness of green betel leaf extract (Piper betel) as a plant-based insecticide on the number of mortality of house flies (Musca domestica). The research was an experimental study used After Only Design used the One Way Anova test with a 95% confidence level. The samples used were 360 house flies. Each treatment of 30 house flies with 4 repetitions and used three concentrations of green betel leaf extract (25%, 50%, 75%). The study was conducted at the Chemistry and Microbiology Laboratory of Health Polytechnic Tanjungpinang, while the location of the fly collection was at the Tokojo Garbage Collection Station in Bintan Regency. The number of mortality of house flies at a concentration of 25% was 81 heads (67.5%), 50% concentrations were 93 heads (77.5%), and at a concentration of 75% were 103 heads (85.83%). There was an effect of green betel leaf extract on the mortality of house flies (p-value 0.0001 <0.05) with the most effective concentration of 75%. Further research is needed to obtain a finished product utilizing green betel leaf extract as a vegetable insecticide, especially in controlling the fly vector. Need further research on the use of green betel leaf extract as a vegetable insecticide controlling the fly vector by taking into account the amount of spraying and the age of the fly. Keywords: Green betel leaf extract , organic insecticide, houseflies

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Awareness of radiation doses and risks among radiology residents, fellows, specialists, consultants and technologists in Jeddah, Saudi Arabia: Cross-Sectional Study. (Preprint)

10.2196/preprints.14460 ◽

2019 ◽

Author(s):

Bashayer Hassan Shuaib ◽

Rahaf Hisham Niazi ◽

Ahmed Haitham Abduljabbar ◽

Mohammed Abdulraheem Wazzan

Keyword(s):

Interventional Radiology ◽

Ionizing Radiation ◽

Statistical Significance ◽

Knowledge Score ◽

P Value ◽

Radiation Doses ◽

Cross Sectional ◽

The Right ◽

Interventional Radiology Procedures ◽

Radiology Staff

BACKGROUND Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. Radiology now plays a major role to diagnose, monitoring, and management of several diseases; numerous diagnostic and interventional radiology procedures involve exposure to ionizing radiation. OBJECTIVE This study aimed to discover and compare the awareness level of radiation doses, protection issues, and risks among radiology staff in Jeddah hospitals. METHODS A cross-sectional survey containing 25 questions on personal information and various aspects of radiation exposure doses and risks was designed using an online survey tool and the link was emailed to all radiology staff in eight tertiary hospitals in Jeddah. The authors were excluded from the study. A P-value of < .05 was used to identify statistical significance. All analyses were performed using SPSS, version 21. RESULTS Out of 156 participants the majority 151 (96.8%) had poor knowledge score, where the mean scores were 2.4±1.3 for doses knowledge, 2.1±1.1for cancer risks knowledge, 2.3±0.6 for general information, and 6.7±1.9 for the total score. Only 34.6% of the participants were aware of the dosage of a single-view chest x-ray, and 9.0% chose the right answer for the approximate effective dose received by a patient in a two-view. 42.9% were able to know the correct dose of CT abdomen single phase. There is a significant underestimation of cancer risk of CT studies especially for CT abdomen where only 23.7% knew the right risk. A p-value of <0.05 was used to identify statistical significance. No significant difference of knowledge score was detected regarding gender (P =.2) or work position (P=.66). CONCLUSIONS Our survey results show considerable inadequate knowledge in all groups without exception. We recommended a conscientious effort to deliver more solid education and obtain more knowledge in these matters and providing periodic training courses to teach how to minimize the dose of radiation and to avoid risk related. CLINICALTRIAL not applicable

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Can diffusion and T2 star-weighted magnetic resonance imaging aid in the diagnosis of ectopic endometrium?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00513-1 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mariam Raafat ◽

Soha H. Talaat ◽

Salma M. Abdelghaffar ◽

Engy A. Ali

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Statistical Significance ◽

P Value ◽

Large Sample Size ◽

Resonance Imaging ◽

Conventional Mri ◽

Patient Will ◽

Magnetic Resonance Imaging Mri ◽

Ectopic Endometrium

Abstract Background Endometriosis is a common gynecologic disorder characterized by the implantation of the endometrial tissue ectopically outside the endometrial cavity. It affects about 10% of females at the childbearing period and is estimated to be present up to 20–50% in women complaining of infertility. While laparoscopy is considered the mainstay for diagnosis, magnetic resonance imaging (MRI) is recognized as a useful tool for definitive diagnosis, pre-surgical planning, and determining whether the patient will require multi-specialty involvement. The aim of this study is to evaluate the performance of MRI with the addition of diffusion-weighted imaging (DWI) and T2 star (T2*) to conventional MRI, for the accurate assessment of ectopic endometrium. Results Endometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2*-weighted images, SE = 80.7% and SP = 71.4% in DWI, and SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05). P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy. Conclusion DWI and T2* significantly increase MRI diagnostic accuracy by allowing the detection of the hemorrhagic character of the endometriotic lesions. Studies with a large sample size are needed to confirm that they can replace invasive laparoscopy for the diagnosis of endometriosis.

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Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

Interventional Neuroradiology ◽

10.1177/15910199211025917 ◽

2021 ◽

pp. 159101992110259

Author(s):

Kainaat Javed ◽

Santiago R Unda ◽

Ryan Holland ◽

Adisson Fortunel ◽

Rose Fluss ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracranial Aneurysms ◽

Statistical Significance ◽

Alpha Angle ◽

Flow Diversion ◽

P Value ◽

Hemorrhagic Complication ◽

Unruptured Intracranial Aneurysms ◽

Hemorrhagic Complications ◽

Groin Hematoma

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

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