Outcomes of endovascular thrombectomy in acute ischemic stroke patients with insulin resistance

BACKGROUND: For patients with acute ischemic stroke (AIS) caused by large vessel occlusion, endovascular thrombectomy (EVT) serves as the standard treatment. However, a significant proportion of patients fail to achieve functional independence despite successful recanalization. While insulin resistance (IR) has been implicated in adverse stroke outcomes, its precise impact on AIS patients undergoing EVT remains incompletely characterized. METHODS: This multicenter cohort study acquired data from the RESCUE-RE registry to explore the association between IR, quantified via the triglyceride glucose (TyG) index, and 90-day functional outcomes in AIS patients undergoing EVT. The primary outcome was functional dependence, defined as a modified Rankin Scale score ≥3 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage, all-cause mortality, early neurological deterioration, and infarct volume at 24 hours, as assessed by follow-up imaging. RESULTS: Among 1305 patients, higher TyG index quartiles were notably associated with unfavorable clinical outcomes. Patients with the highest TyG quartile (Q4) exhibited increased odds of functional dependence (adjusted odds ratio (aOR) 1.79, 95% confidence interval (95% CI) 1.26 to 2.54), early neurological deterioration (aOR 2.48, 95% CI 1.46 to 4.22), and mortality (OR 2.62, 95% CI 1.68 to 4.09) compared with those with the lowest TyG quartile (Q1). Stratified analyses revealed that these associations were more pronounced in younger patients, females, and individuals with hypertension, diabetes, and favorable collateral circulation. Mediation analyses identified inflammation as a partial explanatory factor in the observed relationships. CONCLUSIONS: Insulin resistance is independently associated with deteriorated functional outcomes in AIS patients undergoing EVT.