Is Insulin Resistance Associated With Clinical Outcomes after Endovascular Treatment for Acute Stroke?

Background and Purpose: Insulin Resistance (IR) impact on Acute Ischemic Stroke (AIS) outcomes has been challenging to assess due to the lack of a readily available IR biomarker in acute settings. The Triglyceride-Glucose (TyG) index is a novel surrogate marker for IR that may help bridge this gap. We aimed to evaluate the relationship between IR and clinical outcomes after AIS in patients with large vessel occlusion (LVO). Methods: This single-center retrospective cohort study included patients presenting between 2010 and 2022 with internal carotid artery (ICA) or middle cerebral artery (M1) occlusion who underwent endovascular treatment (EVT). Eligibility criteria were: pre-stroke modified Rankin Scale (mRS) score ≤2 and available fasting triglyceride and glucose levels. The TyG index was calculated as Ln [triglyceride (mg/dL) × glucose (mg/dL)]/2. Multivariable ordinal logistic regression was performed to assess the association between the TyG index and other demographic variables on 90-day mRS. Results: Among 155 patients, 53% were males, and 47% were females. TyG index was significantly associated association with 90-day mRS (OR = 2.04, P < 0.01). Other associated variables included age (OR = 1.05, P < 0.01) and smoking status, with former smokers having lower odds of worse outcomes (OR = 0.44, P = 0.03). Conclusion: Lower TyG index values, indicative of reduced IR, were associated with better functional outcomes following EVT in AIS patients with LVO. Future studies should establish optimal TyG index cut-off values to refine vascular risk management and improve stroke outcomes.