Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

Abstract

BackgroundThis study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of D-dimer levels for endovascular thrombectomy decisions.MethodsWe analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 h with following criteria: age ≥18 years, NIHSS ≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial D-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates.ResultsAmong 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low D-dimer group showed a higher rate of successful recanalization and favorable outcome than the high D-dimer group. The mortality rate was higher in the high D-dimer group. No EVT and high D-dimer level were independent predictors of mortality, whereas lesion volume and low D-dimer level were independently associated with favorable outcomes.ConclusionsD-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

Preprocedural D-Dimer Level as a Predictor of First-Pass Recanalization and Functional Outcome in Endovascular Treatment of Acute Ischemic Stroke

“…Preprocedural D-dimer levels did not differ significantly depending on successful recanalization [13,21,22]. Successful recanalization was conditionally more frequent only in patients with D-dimer levels above the threshold value of successful recanalization [13,23]. In this study, successful recanalization was not associated with preprocedural D-dimer levels; moreover, these levels did not significantly predict successful recanalization and showed unacceptable predictability.…”

“…Third, the prognostic value of preprocedural D-dimer levels has also been evaluated actively in cancer-related stroke. Higher D-dimer levels are consistently associated with unfavorable functional outcome after mechanical thrombectomy in patients with cancer-related stroke [21][22][23]. Because elevated D-dimer levels are a hallmark of cancer-related stroke, patients with higher D-dimer levels might have an underlying or hidden malignancy, which could have contributed to the unfavorable functional outcome in our study.…”

“…First, higher D-dimer levels indicate an active thrombogenic condition mediated by fibrin. Particularly in cancer-related stroke, D-dimer levels are markedly elevated and are a relevant marker for stroke prognosis or pathomechanism [10,[21][22][23]. Thrombi in cancerrelated stroke have been known to be platelet-or fibrin-rich [12,24].…”

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

“…Approximately 28.2% of patients with active malignancy recovered functional independence at 3 months, and it was only 1.7% higher than what was achieved in the non-EVT group of the HERMES37 Collaboration (26.5%). When comparing EVT with no EVT in patients with active malignancy, the non-EVT group showed worse functional outcome39 (15.6%) and higher mortality at 3 months (68.8%). Lee et al 29 reported that an unfavorable outcome was associated with increased serum D-dimer levels and higher baseline NIHSS score in patients with active malignancy after EVT.…”