Background and Purpose: Plasma D-dimer is a complementary diagnostic marker in patients with acute aortic dissection. However, it remains unknown whether monitoring of D-dimer is of diagnostic value for in-hospital management of cerebral artery dissection. The aim of this study was to identify the relationship between D-dimer and neurological deterioration in acute ischemic stroke due to cerebral artery dissection.
Methods: We retrospectively studied 90 consecutive patients (60 men; mean age, 51.0 years) with ischemic stroke due to cerebral or cervical artery dissection who were admitted to our hospital within three weeks after the onset between Jan 2005 and May 2015. Plasma D-dimer values were measured at least on admission and within a week. Neurological deterioration (ND) was defined as an increase of ≥ 3 points in the National Institutes of Health Stroke Scale (NIHSS) score within 3 weeks after admission. D-dimer ratio (DDR, peak D-dimer between the 2nd and 7th hospital day / on admission) was measured as an index of D-dimer elevation at an early phase. Associations between ND and patient characteristics including D-dimer values and acute treatment regimen were examined.
Results: Eight of the 90 patients (8.9%) presented ND, accompanied by progression of stenosis in cerebral artery dissection. None of them had aortic dissection, severe heart failure and active malignant tumor. Fifty-nine of the 90 patients (65.6%) received anticoagulant therapy, 33 (36.7%) antiplatelet therapy and 5 (5.6%) thrombolysis in the acute phase. The mean D-dimer value was 2.80±1.81 (standard deviation, SD) at the time of progression. In univariate analysis, DDR was higher in ND group (3.93±2.45 SD) than non-ND group (1.46±1.04 SD) (p<0.01), whereas the D-dimer value on admission was similar in 2 groups . Multivariate logistic regression analysis showed DDR was related to ND before [OR: 1.57; 95% CI: 1.15-2.38, p<0.01] and after controlling for thrombolysis, anticoagulant therapy and deep vein thrombosis [OR: 1.63; 95% CI: 1.14-2.62, p<0.01].
Conclusion: Early elevation of D-dimer values may predict neurological deterioration with progression of stenosis in acute ischemic stroke due to cerebral artery dissection