D-dimer as an Indicator of Vertebral Artery Dissection: an observational study

Vertebral artery dissection (VAD) diagnoses are sometimes challenging.Associations between VAD and D-dimer has not yet been explored.We conducted a single-center retrospective study to evaluated the usefulness of D-dimer in VAD diagnoses. MethodsAll VAD cases received in the emergency department between January 2013 and June 2020 were reviewed.Comparing those cases to vertigo with benign etiologies, the correlation between VAD and D-dimer was analyzed.Using stepwise multivariate logistic regression, possible symptoms to suspect VAD were also determined from physical findings and laboratory data, including D-dimer. ResultsEleven patients were included in the VAD group, and 59 patients were enrolled in the control (benign vertigo [BV]) group.The most common symptom in VAD patients was vertigo (N-11, 100%), followed by hemiplegia (N = 7, 63%) and cranial neuropathy (N = 7, 63%).Two patients (18%) were free from any symptoms except vertigo.D-dimer was not significantly different between the two groups at the positive cutoff value of 500 ng/mL (p = 1).By stepwise selection, age (odds ratio (OR): 0.92, [0.87-0.98],p < 0.01) and systolic blood pressure (sBP; OR: 1.06 [1.02-1.10],p < 0.01) were selected in the diagnostic model.In combination, age under 60 and sBP over 160 mmHg yielded 63.6% sensitivity, 98.3% specificity, and 37.5 positive likelihood ratio. ConclusionsD-dimer was not found to be an effective indicator of VAD.By contrast, disproportionate hypertension (high blood pressure in young patients) can be a key factor to suspect VAD.