D-Dimer As An Indicator of Vertebral Artery Dissection: A Case Control Study

Abstract

\n Background\n\nVertebral artery dissection (VAD), which can possibly lead to stroke, presents various symptoms such as headache, neck pain, transient ischemic attacks, and vertigo. We evaluated the effect of D-dimer to distinguish VAD from benign diseases by retrospective single-center observational study.\nMethods\n\nAll VAD cases received in the emergency department between January 2013 and June 2020 were reviewed. Comparing those cases to vertigo with benign etiologies, the correlation between VAD and D-dimer was analyzed. Using stepwise multivariate logistic regression, possible symptoms to suspect VAD were also determined from physical findings and some laboratory data, including D-dimer.\nResults\n\nEleven patients were included in the VAD group, and 59 patients were enrolled in the control (benign vertigo [BV]) group. The most common symptom in VAD patients was hemiplegia (N\u2009=\u20097, 63.6%) and cranial neuropathy (N\u2009=\u20097, 63.6%), followed by classic occipital or posterior neck pain (N\u2009=\u20094, 36.4%), gait ataxia (N\u2009=\u20093, 27.3%), and confusion (N\u2009=\u20091, 9.1%). Two patients (18.2%) were free from any symptoms except vertigo. D-dimer was not significantly different between the two groups at the positive cutoff value of 500 ng/mL (p\u2009=\u20091). By stepwise selection, age (odds ratio (OR): 0.92, [0.87–0.98], p\u2009<\u20090.01) and systolic blood pressure (sBP; OR: 1.06 [1.02–1.10], p\u2009<\u20090.01) were selected in the diagnostic model. In combination, age under 60 and sBP over 160 mmHg yielded 63.6% sensitivity, 98.3% specificity, and 37.5 positive likelihood ratio.\nConclusions\n\nIn our study, D-dimer was not found to be an effective indicator of VAD. By contrast, disproportionate hypertension (high blood pressure in young patients) can be a key factor to suspect VAD. Future studies with larger sample sizes are warranted.