Clinical and biochemical diagnosis of small-vessel disease in acute ischemic stroke.
OBJECTIVE
Both from clinical and research standpoints, it may be highly relevant to differentiate between small-artery and large-artery infarction in the acute phase of ischemic stroke. We conducted a study on the added value of two D-dimer assays over clinical assessment for diagnosis of lacunar infarction.


METHODS
Clinical evaluation using the Oxfordshire Community Stroke Project (OCSP) classification and measurement of plasma D-dimer levels by the VIDAS D-dimer test (VIDAS) and the Triage Stroke Panel (TSP) were performed in 128 patients with ischemic stroke presenting within 9 h after onset of symptoms. The stroke subtype was defined as small-artery or large-artery infarction based on the TOAST classification.


RESULTS
The overall accuracy for diagnosing of acute lacunar stroke using the OCSP classification, VIDAS (cut point for D-dimer 445 ng/mL) or TSP (cut point 300 ng/mL) was 89%, 88% and 87% respectively (P<0.001). The conjunctive use of the OCSP classification and VIDAS or TSP improved the accuracy to 97% and 98% respectively (P<0.001). The kappa coefficient for agreement between the two assays was acceptable (kappa, 0.64). These results were reproducible in subgroups of patients presenting within 4.5 h and within 6 h after onset of stroke symptoms.


CONCLUSIONS
Diagnosis of acute lacunar infarction can reliably be made, based on the conjunctive use of clinical evaluation and measurement of D-dimer levels either by a standard assay or by a bedside testing kit.
Brouns
Raf
R
Laboratory for Neurochemistry and Behaviour, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Belgium.
Van Den Bossche
Jan
J
De Surgeloose
Didier
D
Sheorajpanday
Rishi
R
De Deyn
Peter P
PP
D000208:Acute Disease / Q000145:classification; D000368:Aged; D002545:Brain Ischemia / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D013997:Time Factors
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D