Predictive Value of Plasma D-Dimer for Cerebral Herniation Post-Thrombectomy in Acute Ischemic Stroke Patients

Wensheng Zhang,1,2,&ast; Weifang Xing,1,&ast; Jiyun Feng,3,&ast; Yangchun Wen,1 Xiaojing Zhong,1 Li Ling,2,4 Jinzhao He1,5 1Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital, Heyuan, People’s Republic of China; 2Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, People’s Republic of China; 3Department of Neurology, Lianzhou People’s Hospital, Lianzhou, People’s Republic of China; 4The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China; 5Heyuan Key Laboratory of Molecular Diagnosis & Disease Prevention and Treatment, Doctors Station of Guangdong Province, Heyuan People’s Hospital, Heyuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinzhao He, Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital, No. 733 Wenxiang Road, Yuancheng District, Heyuan City, Guangdong Province, 517000, People’s Republic of China, Email hejinzhao2019@163.com Li Ling, Department of Neurology, Shenzhen Hospital, Southern Medical University, The Third School of Clinical Medicine, Southern Medical University, 1333 Xinhu Road, Bao’an District, Shenzhen, Guangdong Province, 518101, People’s Republic of China, Email linglirabbit@163.comBackground: 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.Methods: 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.Results: 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.Conclusion: 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.Keywords: plasma D-dimer, acute cerebral infarction, thrombectomy, cerebral herniation