Triglyceride-glucose index and its association with collaterals in acute ischemic stroke: A cross-sectional study

Leptomeningeal collaterals (LMCs) carry important prognostic value for patients with Acute ischemic stroke (AIS). Insulin resistance (IR) is associated with cardiovascular disease, but its impact on stroke outcomes is less clear. The triglyceride-glucose (TyG) index is a novel, accessible biomarker for IR. This study aims to evaluate the association between TyG index and LMCs.

In this cross-sectional study, we included patients with internal carotid artery or middle cerebral artery occlusion and having CTA within 24 h of symptoms onset. TyG index formula was: ln [triglyceride (mg/dl) × glucose (mg/dl)]/2. CTA collaterals were classified into symmetrical, malignant, and other. Hypoperfusion Intensity Ratio (HIR) calculated from CT perfusion (CTP) was used as secondary marker. We did a multivariate ordinal logistic regression analysis for collaterals and multi linear regression analysis for HIR.

Of 265 patients, 54.1 % were males, and 45.9 % were females, with a mean BMI of 28. A total of 219 (82 %) patients received reperfusion therapy, with 40 % and 74 % patients receiving tPA and EVT, respectively. 39.2 % and 27.2 % of patients had symmetrical and malignant CTA collateral scores, respectively. TyG index was a significant predictor of malignant CTA collaterals (β = 2.2, 95 % CI: 1.7 - 2.7) and CTP HIR (β = 0.1, 95 % CI: 0.03-0.14). TyG > 8.7 had diagnostic accuracy of 0.76 for malignant CTA collaterals.

IR, as measured by TyG index, is predictive of worse LMCs. TyG is a promising biomarker with a potential value in predicting stroke outcomes after reperfusion therapy.