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Title
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Clinical and biochemical diagnosis of small-vessel disease in acute ischemic stroke
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Author
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Abstract
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| Background and purpose 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. |
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Language
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English
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Source (journal)
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Journal of the neurological sciences. - Amsterdam
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Publication
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Amsterdam
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2009
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ISSN
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0022-510X
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DOI
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10.1016/J.JNS.2009.06.032
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Volume/pages
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285
(2009)
, p. 185-190
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ISI
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000270476400033
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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