The triglyceride-glucose (TyG) index has demonstrated a significant association with stroke outcomes. However, its prognostic value in acute ischemic strok

Background The triglyceride-glucose (TyG) index, a simple and reliable surrogate marker of insulin resistance, has been shown to correlate with adverse stroke outcomes. This study aims to evaluate the association between TyG index and outcomes in patients undergoing endovascular treatment (EVT) for large vessel occlusion (LVO) due to different etiologies. Methods A total of 702 patients with acute anterior-circulation LVO due to large artery atherosclerosis (LAA) and cardioembolism (CE), who underwent EVT, were retrospectively included in this study between September 2018 and January 2024. The TyG index was categorized into tertiles: T1 (TyG ≤ 6.92), T2 (6.92 < TyG ≤ 7.60), and T3 (TyG > 7.60). The primary outcome was a shift toward worse outcome on the modified Rankin Scale (mRS). Secondary outcomes included 3-month poor outcome (mRS ≥ 3), successful recanalization, symptomatic intracranial hemorrhage (sICH), and 3-month mortality. Results Among EVT patients (median age 69 years, 55.1% male), the median TyG index was 7.43 (6.93-8.00) for LAA and 7.05 (6.65–7.71) for CE ( p < 0.001). In LAA patients, an elevated TyG index was associated with mRS shift (adjusted odds ratio [OR] = 1.79; 95% CI = 1.34–2.41; p < 0.001), 3-month poor outcome ( OR = 1.61; 95% CI = 1.13–2.34; p = 0.009), and mortality (OR = 1.77; 95% CI = 1.12–2.82; p = 0.015), but not with successful recanalization or sICH. Similar association was also oberved in CE or all patients. However, there was no significant CE/LAA and TyG index interaction on any outcome. Conclusion This study found that while the TyG index differed between LAA and CE patients with LVO undergoing EVT, elevated TyG index was associated with worse clinical outcomes in both groups.