To evaluate the association between Triglyceride-glucose (TyG) index and risk of acute ischemic stroke (AIS) core progression among patients undergoing reperfusion therapy 

Infarct core progression in AIS is vital in predicting stroke outcomes, especially after reperfusion therapy. Hypoperfusion intensity ratio (HIR) is a biomarker calculated from CT perfusion (CTP) which is used as a predictor of collaterals, stroke core progression, and outcomes. Insulin resistance (IR) is associated with cardiovascular disease, but its impact on AIS is less clear. The TyG index, a novel IR biomarker, is more accessible than Hyperinsulinemic-euglycemic clamp in clinical practice.

In this single-center study, we chart reviewed patients presenting between 2010 and 2022, with either internal carotid artery (ICA) or middle cerebral artery (M1) occlusion, having CTP within 24 hours of symptoms onset, and having fasting triglyceride and glucose levels. TyG index formula was: ln [triglyceride (mg/dl) × glucose (mg/dl)]/2. HIR was calculated by dividing the volume of tissue with a time-to-maximum (Tmax) of >10 seconds by Tmax of >6 seconds. Higher HIR indicates worse collaterals and higher risk of core progression. Univariable linear regression was first used to assess the predictive value of TyG and other variables on HIR, only significant variables were fitted into the final multivariable linear regression model.

Of 148 patients enrolled in our analysis, 52% were males, and 48% were females, with a mean BMI of 27.4. 127 out of 148 patients had MCA involvement, and 64 patients had cardioembolic stroke, which was the most common etiology. 31.8% received thrombolysis, and 74% underwent EVT. TyG index was a significant predictor of higher HIR (β coefficient of 0.1, p < 0.01).

TyG index, a surrogate marker for insulin resistance predicts infarct core progression in AIS. TyG is a promising biomarker with a potential value in predicting stroke outcomes after reperfusion therapy.