Plasma D-dimer can predict all-cause mortality after mechanical thrombectomy of anterior circulation noncardioembolic acute cerebral infarction.

Abstract

Background and objective: There is relatively little data on all-cause mortality within 3 months after successful mechanical thrombectomy for noncardioembolic acute cerebral infarction in the anterior circulation. The purpose of this study is to explore the predictive effect of emergency preoperative plasma D-dimer on all-cause mortality within 3 months after successful mechanical thrombectomy of anterior circulation noncardioembolic acute cerebral infarction.

Methods: A retrospective analysis was conducted on the clinical data of 186 patients with anterior circulation noncardioembolic acute cerebral infarction who underwent successful mechanical thrombectomy.

Results: Among 186 patients (aged 64.26 ± 11.62 years), 8 patients (4.30%) experienced all-cause mortality within 3 months after surgery. Compared with non deceased patients, deceased patients had a higher proportion of female, higher NIHSS score at admission, lower preoperative Alberta Stroke Program Early Computed Tomography (ASPECT) score, lower collateral circulation score, lower proportion of grade 3 reperfusion blood flow classification, and higher levels of emergency preoperative plasma D-dimer (P<0.05). After adjusting for confounding factors, female (odds ratio (OR)=15.389; 95% confidence interval (CI) 1.219-194.279; P=0.035) and emergency preoperative plasma D-dimer (OR=1.271; 95% CI 1.084-1.491; P=0.003) were significantly associated with all-cause mortality within 3 months after surgery. The area under the ROC curve for predicting all-cause mortality using plasma D-dimer is 0.822 (sensitivity 0.875, specificity 0.831), with a cutoff value of 2.065ug/ml.

Conclusion: Preoperative plasma D-dimer is an independent predictor of all-cause mortality within 3 months after successful mechanical thrombectomy for noncardioembolic acute cerebral infarction of anterior circulation. Patients with plasma D-dimer level ≥ 2.065ug/ml have a greater chance of experiencing symptomatic cerebral hemorrhage, malignant cerebral edema, and cerebral herniation.