血管内治疗的卒中患者术后血浆D-二聚体水平可能预测再通失败。

Post-procedural plasma D-dimer level may predict futile recanalization in stroke patients with endovascular treatment.

作者信息

Zhao Min, Dai Zhengze, Liu Rui, Liu Xinfeng, Xu Gelin

机构信息

Department of Intensive Care Unit, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029 Jiangsu, China; Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002 Jiangsu, China.

Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, 210031 Jiangsu, China.

出版信息

J Stroke Cerebrovasc Dis. 2025 May;34(5):108248. doi: 10.1016/j.jstrokecerebrovasdis.2025.108248. Epub 2025 Jan 23.

DOI:10.1016/j.jstrokecerebrovasdis.2025.108248

PMID:39863190

Abstract

OBJECTIVE

High d-dimer levels may increase the likelihood of unfavorable clinical outcomes in patients with acute ischemic stroke. However, the impacts of serum d-dimer levels on outcomes of reperfusion treatment in patients with acute ischemic stroke have not been evaluated. This study aims to assess a possible relationship between serum d-dimer and functional outcomes in stroke patients with endovascular treatment (EVT).

METHODS

Patients with acute ischemic stroke who underwent successful EVT were enrolled. Plasma d-dimer was measured before and within 6 h after endovascular procedures. Futile recanalization was defined as a modified Rankin Scale score of 3-6 at 90 days of stroke onset. Multivariable logistic regression analyses were performed to determine the relationships between d-dimer and futile recanalization.

RESULTS

Of the 161 enrolled patients, 78 (48.4 %) were classified as futile recanalization. After adjusting for potential confounders, high post-procedural d-dimer level was associated with futile recanalization (odds ratio, 1.25; 95 % CI, 1.05-1.51; P = 0.016). In patients with futile recanalization, change in serum d-dimer levels increased significantly after EVT (P < 0.001). Furthermore, change in d-dimer level after EVT was associated with futile recanalization (odds ratio, 1.33; 95 % CI, 1.11-1.65; P = 0.005) independently.

CONCLUSIONS

High post-procedural plasma d-dimer levels and a significant increase in d-dimer after EVT may predict futile recanalization in patients with acute ischemic stroke.

摘要

目的

高D-二聚体水平可能增加急性缺血性脑卒中患者出现不良临床结局的可能性。然而，血清D-二聚体水平对急性缺血性脑卒中患者再灌注治疗结局的影响尚未得到评估。本研究旨在评估血清D-二聚体与接受血管内治疗（EVT）的脑卒中患者功能结局之间的可能关系。

方法

纳入成功接受EVT的急性缺血性脑卒中患者。在血管内操作前及操作后6小时内测量血浆D-二聚体。无效再通定义为卒中发病90天时改良Rankin量表评分为3-6分。进行多变量逻辑回归分析以确定D-二聚体与无效再通之间的关系。

结果

在161例纳入患者中，78例（48.4%）被分类为无效再通。在调整潜在混杂因素后，术后高D-二聚体水平与无效再通相关（比值比，1.25；95%可信区间，1.05-1.51；P = 0.016）。在无效再通的患者中，EVT后血清D-二聚体水平变化显著增加（P < 0.001）。此外，EVT后D-二聚体水平变化与无效再通独立相关（比值比，1.33；95%可信区间，1.11-1.65；P = 0.005）。