Title : Peri-procedural D-dimer dynamics predict 90-day functional outcome after mechanical thrombectomy: A retrospective cohort study
Abstract:
Background: Mechanical thrombectomy is an established treatment for acute ischemic stroke caused by large-vessel occlusion, but functional recovery remains heterogeneous even after endovascular therapy. D-dimer may reflect ongoing coagulation activation, fibrinolysis, thrombus burden, and postprocedural biological stress. This study evaluated whether peri-procedural D-dimer dynamics were associated with 90-day functional outcome after mechanical thrombectomy, with additional comparison between anterior and posterior circulation stroke.
Methods: This retrospective observational cohort study included 342 patients with acute ischemic stroke who underwent mechanical thrombectomy. Preoperative D-dimer was defined as the value obtained within 1 hour before thrombectomy, postoperative D-dimer as the value obtained within 24 hours after thrombectomy, and change in D-dimer as postoperative minus preoperative D-dimer. The primary outcome was poor 90-day functional outcome, defined as modified Rankin Scale score 3–6. Patients were also categorized according to anterior or posterior circulation territory. Univariable and multivariable logistic regression analyses were performed, and receiver operating characteristic curve analysis was used to assess discriminatory performance.
Results: Among 342 patients, 263 (76.9%) had anterior circulation stroke and 79 (23.1%) had posterior circulation stroke. Poor 90-day functional outcome occurred in 207 patients (60.5%). Patients with poor outcome had higher preoperative D-dimer [1.09 (0.50–2.77) vs 0.72 (0.35–1.76)], postoperative D-dimer [3.30 (1.47–6.13) vs 1.79 (0.81–3.42)], and change in D-dimer [1.44 (0.16–4.38) vs 0.59 (−0.12–1.83)] than patients with good outcome. In the primary multivariable model, change in D-dimer remained independently associated with poor outcome (adjusted OR 1.06, 95% CI 1.01–1.11; p=0.014), together with severe baseline stroke (NIHSS ≥16; adjusted OR 2.28, 95% CI 1.40–3.71; p=0.001). In the supportive model, postoperative D-dimer was also independently associated with poor outcome (adjusted OR 1.09, 95% CI 1.02–1.15; p=0.005). Posterior circulation stroke was associated with worse crude outcome, but not independently associated with poor outcome after adjustment. ROC analysis showed modest discrimination, with AUCs of 0.649 for postoperative D-dimer and 0.606 for change in D-dimer.
Conclusions: Peri-procedural D-dimer dynamics were associated with poor 90-day functional outcome after mechanical thrombectomy. Postoperative D-dimer and D-dimer change appeared more informative than preoperative D-dimer alone, while baseline neurological severity remained an important clinical predictor. D-dimer dynamics may serve as an adjunctive prognostic biomarker after thrombectomy, but modest discriminatory performance supports cautious interpretation and prospective validation.
Keywords: Acute ischemic stroke; Mechanical thrombectomy; D-dimer; Functional outcome; Modified Rankin Scale; Posterior circulation; Prognostic biomarker.
