Zhang Wensheng, Xing Weifang, Feng Jiyun, Wen Yangchun, Zhong Xiaojing, Ling Li, He Jinzhao
Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, People's Republic of China.
Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, People's Republic of China.
Int J Gen Med. 2024 Dec 3;17:5737-5746. doi: 10.2147/IJGM.S499124. eCollection 2024.
Cerebral hernia is a serious complication after thrombectomy in patients with acute ischemic stroke (AIS). This study aims to explore the predictive value of emergency preoperative plasma D-dimer levels in cerebral herniation after successful thrombectomy.
Between January 2019 and December 2023, patients with AIS who received a successful thrombectomy in our single comprehensive stroke center were retrospectively enrolled. We conducted a statistical analysis on the data using SPSS 26.0. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of D-dimer level for cerebral herniation.
Among 278 enrolled patients, 20 cases (7.19%) experienced cerebral herniation. In patients with cerebral hernia, the score of the National Institutes of Health Stroke Scale was higher (16.5 vs 12.0, P < 0.001), the Alberta Stroke Plan early CT score was lower (6.5 vs 8.0, P < 0.001), the score of collateral circulation was lower (2.0 vs 3.0, P < 0.001), the proportion of eTICI blood flow grading of 3 of the occluded vessel was less (35% vs 75.19%), the proportion of pathogenesis of large atherosclerosis was less (5.00% vs 46.51%, P < 0.001), and the level of plasma D-dimer was higher (2.61 vs 0.82). After adjusting for potential confounders, the level of D-dimer (adjusted OR = 1.131, 95% CI 1.022-1.250, P = 0.017) was significantly correlated with cerebral hernia. Based on the ROC curve, the sensitivity and specificity of D-dimer in predicting cerebral herniation were 75.0% and 73.3%, respectively, and the area under the curve was 0.766.
Although our study had certain limitations, we found that elevated emergency preoperative plasma D-dimer level is an independent predictive factor for the cerebral herniation after successful thrombectomy in patients with AIS, which is of great clinical significance.
脑疝是急性缺血性卒中（AIS）患者血栓切除术后的严重并发症。本研究旨在探讨急诊术前血浆D - 二聚体水平对成功血栓切除术后脑疝的预测价值。
回顾性纳入2019年1月至2023年12月在我们单一的综合卒中中心接受成功血栓切除术的AIS患者。我们使用SPSS 26.0对数据进行统计分析。采用受试者操作特征曲线（ROC）评估D - 二聚体水平对脑疝的预测价值。
在278例纳入患者中，20例（7.19%）发生脑疝。脑疝患者中，美国国立卫生研究院卒中量表评分更高（16.5对12.0，P < 0.001），阿尔伯塔卒中计划早期CT评分更低（6.5对8.0，P < 0.001），侧支循环评分更低（2.0对3.0，P < 0.001），闭塞血管eTICI血流分级为3级的比例更低（35%对75.19%），大动脉粥样硬化发病机制的比例更低（5.00%对46.51%，P < 0.001），血浆D - 二聚体水平更高（2.61对0.82）。在调整潜在混杂因素后，D - 二聚体水平（调整后OR = 1.131，95%CI 1.022 - 1.250，P = 0.017）与脑疝显著相关。基于ROC曲线，D - 二聚体预测脑疝的敏感性和特异性分别为75.0%和73.3%，曲线下面积为0.766。
尽管我们的研究有一定局限性，但我们发现急诊术前血浆D - 二聚体水平升高是AIS患者成功血栓切除术后脑疝的独立预测因素，具有重要的临床意义。
