Abstract
BACKGROUND: This study aims to evaluate the association between the triglyceride-glucose (TyG) index and outcomes in large vessel occlusion (LVO) patients undergoing endovascular therapy (EVT) with different etiologies. METHODS: A total of 702 patients with acute anterior-circulation LVO due to large artery atherosclerosis (LAA) and cardioembolism (CE), who underwent EVT, were retrospectively included in this study between September 2018 and January 2024. Patients were stratified into three groups based on tertiles of the TyG index. The primary outcome was poor outcome, defined as 3-month modified Rankin Scale (mRS) score ≥ 3. Secondary outcomes included 3-month mRS, symptomatic intracranial hemorrhage (sICH), and 3-month mortality. RESULTS: Among EVT patients (median age 69 years, 55.1% male), the median TyG index was 9.02 (8.53–9.59) for LAA and 8.65 (8.24–9.30) for CE (p < 0.001). In LAA patients, an elevated TyG index was associated with poor outcome (adjusted odds ratio [OR] = 1.49; 95% CI = 1.04–2.15; p = 0.031), 3-month mRS (OR = 1.59; 95% CI = 1.09–2.35; p = 0.019), and mortality (OR = 1.67; 95% CI = 1.05–2.70; p = 0.032), but not with sICH. Similar association was also oberved in CE or all patients. However, there was no significant CE/LAA and TyG index interaction on any outcome. CONCLUSION: This study found that while the TyG index differed between LAA and CE patients with LVO undergoing EVT, an elevated TyG index was associated with worse clinical outcomes in both groups. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-026-04787-8.