Post-procedural Plasma D-dimer Level May Predict Futile Recanalization in Stroke Patients with Endovascular Treatment

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 hours 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.