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Background <p>Acute basilar artery occlusion (BAO) represents an uncommon but highly devastating form of ischemic stroke, frequently resulting in severe disability or death, despite advances in endovascular treatment (EVT). Although insulin resistance (IR) has been connected to poorer neurological outcomes after stroke, evidence regarding the predictive usefulness of non-insulin-based IR indices in BAO patients receiving EVT is still limited.</p> Methods <p>In this study, 266 BAO patients who received EVT between 2012 and 2024 were analyzed. Three IR indices were calculated at admission: the triglyceride–glucose (TyG) index, the metabolic score for insulin resistance (METS-IR), and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C). The primary endpoint included a 90-day unfavorable outcome (modified Rankin scale score: 4–6), and the secondary endpoints included mortality and symptomatic intracranial hemorrhage (sICH). Associations were examined by using multivariable regression, and discriminative ability was quantified via receiver operating characteristic analysis.</p> Results <p>In 266 patients, 149 (56.0%) demonstrated unfavorable outcomes, and 77 (28.9%) died within 90 days. Higher TyG values showed a robust association with unfavorable outcomes, mortality, and sICH; moreover, it provided the strongest predictive ability for functional outcomes (area under the curve comparisons, <i>P</i> &lt; 0.05). METS-IR was associated with mortality and demonstrated a predictive ability comparable to that of TyG but weaker for functional outcome. TG/HDL-C was not significantly related to any outcome.</p> Conclusions <p>Among BAO patients who underwent EVT, the TyG index could strongly predict unfavorable functional recovery and mortality, whereas the METS-IR was mainly associated with mortality. These findings indicate that TyG may help in refining risk stratification after EVT, whereas METS-IR appears to be less informative.</p>

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Association of insulin resistance indices with outcomes after endovascular treatment in acute basilar artery occlusion

  • 期刊论文

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  • 发表日期：

    2025年12月10日

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  • Qiuting Wang,
  • Na Liu,
  • Lu Yang,
  • Chuanjie Wu,
  • Wenbo Zhao,
  • Longfei Wu,
  • Liqun Jiao,
  • Sijie Li,
  • Qingfeng Ma,
  • Xunming Ji,
  • Chuanhui Li

摘要

Background

Acute basilar artery occlusion (BAO) represents an uncommon but highly devastating form of ischemic stroke, frequently resulting in severe disability or death, despite advances in endovascular treatment (EVT). Although insulin resistance (IR) has been connected to poorer neurological outcomes after stroke, evidence regarding the predictive usefulness of non-insulin-based IR indices in BAO patients receiving EVT is still limited.

Methods

In this study, 266 BAO patients who received EVT between 2012 and 2024 were analyzed. Three IR indices were calculated at admission: the triglyceride–glucose (TyG) index, the metabolic score for insulin resistance (METS-IR), and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C). The primary endpoint included a 90-day unfavorable outcome (modified Rankin scale score: 4–6), and the secondary endpoints included mortality and symptomatic intracranial hemorrhage (sICH). Associations were examined by using multivariable regression, and discriminative ability was quantified via receiver operating characteristic analysis.

Results

In 266 patients, 149 (56.0%) demonstrated unfavorable outcomes, and 77 (28.9%) died within 90 days. Higher TyG values showed a robust association with unfavorable outcomes, mortality, and sICH; moreover, it provided the strongest predictive ability for functional outcomes (area under the curve comparisons, P < 0.05). METS-IR was associated with mortality and demonstrated a predictive ability comparable to that of TyG but weaker for functional outcome. TG/HDL-C was not significantly related to any outcome.

Conclusions

Among BAO patients who underwent EVT, the TyG index could strongly predict unfavorable functional recovery and mortality, whereas the METS-IR was mainly associated with mortality. These findings indicate that TyG may help in refining risk stratification after EVT, whereas METS-IR appears to be less informative.