Association between the triglyceride-glucose index and collateral status in ischemic stroke patients undergoing endovascular therapy

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.