Title: Significance of D-dimer in acute ischemic stroke patients with large vessel occlusion accompanied by active cancer

Abstract

Background: This 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.Methods: We analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 hours 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. Results: Among 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. 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.Conclusions: d-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.