Background Collateral status provides compensatory flow to ischemic regions in acute large vessel occlusion (LVO) patients and is closely linked to clinical outcomes after endovascular therapy (EVT). This study aimed to evaluate the association between the triglyceride-glucose (TyG) index and collateral status in ischemic stroke patients undergoing EVT, focusing on sex-based differences. Methods A total of 789 patients undergoing EVT between September 2018 and January 2024 were retrospectively included in this study. Collateral status was assessed using the ASITN/SIR grading system based on digital subtraction angiography (DSA), classifying patients into poor (grades 0–1) and good (grades 2–4) collateral groups. The association between the TyG index and collateral status was evaluated using multivariable logistic regression analysis, and restricted cubic spline modeling. Results Among EVT patients (median age 69 years, 55.8% male), 256 were included in poor collateral group. The TyG index was significantly elevated in patients with poor collaterals compared to those with good collaterals (8.86 [8.43, 9.54] vs. 8.74 [8.35, 9.30], P = 0.021). Logistic regression analysis revealed that an elevated TyG index was independently associated with the risk of poor collateral status (OR = 1.30, 95% CI: 1.05–1.62, P = 0.017), with the association being significant in males (OR = 1.50, 95% CI: 1.08–2.08, P = 0.016) but not in females (OR = 1.21, 95% CI: 0.90–1.64, P = 0.205). In addition, restricted cubic spline modeling showed a positive linear association between the TyG index and poor collateral status in the total patients and males. Conclusion In this study, we found that the TyG index was significantly associated with poor collateral status in patients undergoing EVT, particularly in males.

Background: Although landmark trials showed favorable outcomes with endovascular therapy (EVT) for large ischemic stroke, imaging protocols for patient inclusion varied. This study aims to explore the interaction between computed tomography angiography (CTA) imaging characteristics and the association of EVT with outcomes in real-world clinical practice. Methods: This was a subanalysis of a prospective cohort study that enrolled patients with large vessel occlusion and ASPECTS 0–5 from 38 stroke centers across China between November 2021 and February 2023. Based on admission CTA imaging, the occlusion site, Tan score, cortical vein opacification score (COVES), internal cerebral veins (ICV), and clot burden score were assessed. The primary outcome was the 90-day modified Rankin Scale (mRS). Treatment effects across subgroups based on CTA imaging characteristics were analyzed using ordinal regression analysis, and interaction analysis was performed to assess whether these characteristics modified the effect of EVT on 90-day mRS. Results: Among the 460 patients (255 male, 55.4%), the EVT group was younger than SMT group (67 years [IQR, 58–77] vs. 72 years [IQR, 65–79]). COVES and Tan score significantly modified the association between EVT and 90-day mRS ( P < 0.001 and P = 0.023 for interaction, respectively), with a larger effect size observed in patients with COVES 3–6 (adjusted common odds ratio [acOR], 2.43 [95% CI, 1.39–4.27]; P = 0.002) and Tan score 2–3 (acOR, 2.78 [95% CI, 1.24–6.24]; P = 0.013). In contrast, occlusion site, ICV score, and clot burden score did not modify the effect of EVT. Conclusion: Better arterial and venous collaterals in patients with large ischemic stroke are associated with favorable outcomes and may modify the effect of EVT. This analysis provides preliminary evidence supporting the role of baseline CTA imaging in guiding EVT selection for these patients.

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.

This study aims to evaluate the association between the triglyceride-glucose (TyG) index and outcomes in large vessel occlusion (LVO) patients undergoing e