Impact of insulin resistance partially mediating symptomatic intracranial hemorrhage on futile recanalization in large vessel occlusion patients
5 affiliations
- 1Department of Neurology, Dianjiang People’s Hospital of Chongqing
- 2Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University
- 3Department of Neurology, the First Affiliated Hospital of Chongqing Medical University
- 4Department of Internal Medicine, West China Second University Hospital, Sichuan University
- 5Department of Neurology, Chongqing University Three Gorges Hospital
Abstract
Insulin resistance (IR) contributes to the development of the no-reflow phenomenon in acute myocardial infarction patients following coronary revascularization. However, the impact of IR on futile recanalization for anterior circulation large vessel occlusion (LVO) patients following endovascular treatment (EVT) remains unclear. This study was based on a multicenter cohort. Acute ischemic stroke patients with LVO who underwent successful EVT within 24 h of symptom onset were enrolled. IR was assessed by the triglyceride-glucose (TyG) index, obtained as ln [fasting TG (mg/dl) × FBG (mg/dl)/2]. The primary outcome was futile recanalization (90-day modified Rankin Scale [mRS] score 3–6 despite successful recanalization). Symptomatic intracranial hemorrhage was assessed as an independent short-term outcome and evaluated as a potential mediator between TyG and futile recanalization. Of 860 patients screened for eligibility, 608 patients who achieved recanalization were included. Enrolled patients were divided into three groups based on the TyG index levels (tertile [T] 1: 5.45–8.41; T2: 8.41–8.95; T3: 8.95–10.97). After adjustment for confounders, the T3 group had a higher proportion of futile recanalization than the T1 and T2 groups (T3 vs. T1: adjusted OR: 2.08, 95% CI 1.30–3.33, P = 0.002; T3 vs. T2: adjusted OR: 1.89, 95% CI 1.18–3.02, P = 0.008). The restricted cubic splines regression model revealed that the risk of futile recanalization and symptomatic intracranial hemorrhage (sICH) increased linearly with elevated TyG index. Mediation analysis showed that sICH partially mediated an estimated 17.4% (95% CI 1.3–58.0%) of the association between a higher TyG index and futile recanalization. The TyG index is a robust risk factor for symptomatic intracranial hemorrhage and futile recanalization in acute LVO patients who achieved successful recanalization.
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BibTeX
@article{gao2026impact,
title = {{Impact of insulin resistance partially mediating symptomatic intracranial hemorrhage on futile recanalization in large vessel occlusion patients}},
author = {Lin Gao and Chen Gong and Zhiyuan Wang and Shuyu Jiang and Liping Huang and Yuetao Wen and Yuan Tao and Junling Fu and Zhiyu Xiong and Yunyi Huang and Shengli Chen and Lina Zhang},
journal = {Scientific Reports},
year = {2026},
month = aug,
doi = {10.1038/s41598-026-64764-6},
url = {https://doi.org/10.1038/s41598-026-64764-6},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of insulin resistance partially mediating symptomatic intracranial hemorrhage on futile recanalization in large vessel occlusion patients
AU - Lin Gao
AU - Chen Gong
AU - Zhiyuan Wang
AU - Shuyu Jiang
AU - Liping Huang
AU - Yuetao Wen
AU - Yuan Tao
AU - Junling Fu
AU - Zhiyu Xiong
AU - Yunyi Huang
AU - Shengli Chen
AU - Lina Zhang
PY - 2026
DA - 2026/08/01
JO - Scientific Reports
DO - 10.1038/s41598-026-64764-6
UR - https://doi.org/10.1038/s41598-026-64764-6
AB - Insulin resistance (IR) contributes to the development of the no-reflow phenomenon in acute myocardial infarction patients following coronary revascularization. However, the impact of IR on futile recanalization for anterior circulation large vessel occlusion (LVO) patients following endovascular treatment (EVT) remains unclear. This study was based on a multicenter cohort. Acute ischemic stroke patients with LVO who underwent successful EVT within 24 h of symptom onset were enrolled. IR was assessed by the triglyceride-glucose (TyG) index, obtained as ln [fasting TG (mg/dl) × FBG (mg/dl)/2]. The primary outcome was futile recanalization (90-day modified Rankin Scale [mRS] score 3–6 despite successful recanalization). Symptomatic intracranial hemorrhage was assessed as an independent short-term outcome and evaluated as a potential mediator between TyG and futile recanalization. Of 860 patients screened for eligibility, 608 patients who achieved recanalization were included. Enrolled patients were divided into three groups based on the TyG index levels (tertile [T] 1: 5.45–8.41; T2: 8.41–8.95; T3: 8.95–10.97). After adjustment for confounders, the T3 group had a higher proportion of futile recanalization than the T1 and T2 groups (T3 vs. T1: adjusted OR: 2.08, 95% CI 1.30–3.33, P = 0.002; T3 vs. T2: adjusted OR: 1.89, 95% CI 1.18–3.02, P = 0.008). The restricted cubic splines regression model revealed that the risk of futile recanalization and symptomatic intracranial hemorrhage (sICH) increased linearly with elevated TyG index. Mediation analysis showed that sICH partially mediated an estimated 17.4% (95% CI 1.3–58.0%) of the association between a higher TyG index and futile recanalization. The TyG index is a robust risk factor for symptomatic intracranial hemorrhage and futile recanalization in acute LVO patients who achieved successful recanalization.
SN - 2045-2322
ER -