Journal
JOURNAL OF THE NEUROLOGICAL SCIENCES
Volume 413, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.jns.2020.116814
Keywords
D-dimer; Large vessel occlusion; Risk factor; Minor ischaemic stroke; Ischaemic stroke; Stroke
Categories
Funding
- Intramural Research Fund for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center [H29-1-1]
- Japan Agency for Medical Research and Development [AMED: 19ek0210091h0003, 19lk0201094h0001]
- JSPS KAKENHI [JP17H04308]
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Objective: To determine the predictors of unfavorable outcomes in acute minor ischemic stroke patients with large vessel occlusion. Methods: The derivation cohort included ischemic stroke patients admitted to a comprehensive stroke center within 7 days after onset with large vessel occlusion and an initial National Institutes of Health Stroke Scale score of 5 or less. An unfavorable outcome was defined as dependency (modified Rankin Scale score of 3 to 6) at 3 months from the onset. The predictive values of factors related to an unfavorable outcome were evaluated. External validation was performed from a stroke registry of a tertiary medical center. Results: In the derivation cohort, 3839 consecutive patients were screened; a total of 130 patients were included. Twenty-four (18%) patients had unfavorable outcomes. In multivariate analysis, D-dimer >= 1900 mu g/l (odds ratio (OR) 3.31, 95% confidence interval (CI) 1.14-9.61, p = .028) and age (OR 2.01, 95% CI 1.05-3.86, p=.035) were independently associated with an unfavorable outcome. No significant differences were observed regarding occluded vessel sites. In the validation cohort, 850 consecutive patients were screened; a total of 74 patients were included. D-dimer >= 1900 mu g/l (OR 8.78, 95% CI 1.41-54.61, p = .020) was the only factor independently associated with an unfavorable outcome, as in the derivation cohort. Conclusions: A high D-dimer level on admission could help predict unfavorable outcomes in patients with a minor ischemic stroke with large vessel occlusion.
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