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Plasma D-dimer can predict malignant brain edema after thrombectomy in noncardioembolic acute cerebral infarction

Wensheng Zhang1,2,3,4, Zhenqin Jiang1, Yangchun Wen5

  • 1Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Heyuan, Guangdong Province, China.

BMC Neurology
|July 3, 2026
PubMed
Abstract

Insights

Malignant brain edema (MBE) occurred in 16.13% of patients after mechanical thrombectomy (MT) for acute cerebral infarction. Emergency preoperative plasma D-dimer showed a modest ability to predict MBE, which is linked to poorer patient outcomes.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Neuroradiology

Background:

  • Malignant brain edema (MBE) is a severe complication following acute cerebral infarction.
  • Limited data exists on MBE incidence and predictors after mechanical thrombectomy (MT) for non-cardioembolic anterior circulation large vessel occlusion (LVO).

Purpose of the Study:

  • To investigate the incidence of MBE after successful MT in this specific patient population.
  • To identify predictors of MBE, focusing on emergency preoperative plasma D-dimer levels.
  • To evaluate the clinical prognosis of patients who develop MBE.

Main Methods:

  • Retrospective analysis of 186 patients undergoing successful MT for anterior circulation non-cardioembolic acute cerebral infarction.
  • Collection and analysis of clinical, imaging, laboratory, and treatment data at admission.
  • Statistical analysis including logistic regression and ROC curve analysis to identify predictors and assess predictive performance.

Main Results:

  • MBE developed in 16.13% of patients (30/186).
  • MBE was associated with a lower 3-month good prognosis rate and higher mortality.
  • Predictors of MBE included lower ASPECT score, tandem lesions, poor collateral circulation, and elevated emergency preoperative plasma D-dimer (OR=1.155, P=0.044).
  • The AUC for D-dimer predicting MBE was 0.706.

Conclusions:

  • Emergency preoperative plasma D-dimer is a modest predictor of MBE in non-cardioembolic acute cerebral infarction post-MT.
  • MBE significantly worsens neurological independence at 3 months.
  • Larger prospective studies are needed to validate these preliminary findings.
Keywords:
Malignant brain edemaMechanical thrombectomyNoncardioembolic acute cerebral infarctionPlasma D-dimer

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