Key result
Higher D-dimer levels linked to ~19% lower odds of first pass effect in stroke thrombectomy.
Why the study?
Evidence on plasma biomarkers to identify first pass effect in patients with acute ischemic stroke and large vessel occlusion treated with thrombectomy was limited.
Does emergency admission plasma D-dimer level predict first pass effect (mTICI ≥2c) in patients with acute ischemic stroke with large vessel occlusion undergoing first-line stent retriever thrombectomy?
Observational (n=313)
No
Does emergency admission plasma D-dimer level predict first pass effect (mTICI ≥2c) in patients with acute ischemic stroke with large vessel occlusion undergoing first-line stent retriever thrombectomy?
Low emergency admission plasma D-dimer level is an independent predictor of achieving first pass effect in acute ischemic stroke patients with large vessel occlusion treated with stent retriever thrombectomy.
D-dimer assessment should not yet guide thrombectomy decisions; hypothesis-generating for biomarker integration in large-vessel occlusion.
Background Evidence on plasma biomarkers to identify first pass effect (FPE) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) treated with thrombectomy is limited. Purpose To evaluate whether plasma D-dimer could predict FPE. Material and Methods Consecutive patients with LVO who underwent first-line stent retriever thrombectomy at our center between January 2018 and August 2021 were enrolled. Patients were classified into the FPE (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2c) group or non-FPE (mTICI 0–2b) group based on angiographic outcomes. Logistic regression analysis was performed to determine the predictors of FPE. The overall ability of D-dimer levels in predicting FPE was evaluated using receiver operating characteristic (ROC) curves. Results In total, 313 patients were included; 88 (28.1%) patients achieved FPE. Compared to those with non-FPE, patients with FPE had more diabetes mellitus history, lower D-dimer levels, higher clot burden score, a higher proportion of M1 middle cerebral artery, and a higher proportion of main stem occlusion pattern ( P <0.05). After adjusting for potential variables, D-dimer levels (OR=0.81, 95% CI=0.52–0.96), clot burden score (OR=1.76, 95% CI=1.38–2.87), and main stem occlusion pattern (OR=1.85, 95% CI=1.19–2.62) remained independently associated with FPE. Based on the ROC analysis, the D-dimer as a predictor for predicting FPE presented with a specificity of 79%, a negative predictive value of 87%, and an area under the curve of 0.761. Conclusion Low emergency admission plasma D-dimer level is an independent predictor of FPE in patients with AIS treated with stent retriever thrombectomy.
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Xie et al. (2023) conducted an observational in Acute ischemic stroke with large vessel occlusion (n=313). Emergency admission plasma D-dimer level was evaluated on First pass effect (modified Thrombolysis in Cerebral Infarction [mTICI] >=2c) (OR 0.81, 95% CI 0.52-0.96, p=<0.05). Plasma D-dimer levels were independently associated with first pass effect in stent retriever thrombectomy for acute ischemic stroke (OR 0.81, 95% CI 0.52-0.96; AUC 0.761).
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