Abstract
BACKGROUND: The stress hyperglycemia ratio (SHR) is associated with unfavorable functional outcomes in patients with large vessel occlusion. The potential effect of SHR on tissue-level collaterals (TLC) and futile recanalization is not clear. METHODS: This is a multicenter retrospective cohort study of patients with consecutive acute ischemic stroke due to large vessel occlusion (AIS-LVO) receiving endovascular treatment (EVT). The included patients had baseline glucose/HbA1c measurements and underwent cerebral perfusion imaging. TLC were measured using the hypoperfusion intensity ratio (HIR) [the volume ratio of brain tissue with (T (max) > 10 s/T (max) > 6 s)]. SHR was calculated as blood glucose (mmol/L)/[1.59 × HbA1C (%) - 2.59]. Using multivariable regression and mediation analyses, we determined the association among SHR, the TLC status, and futile recanalization (90-day modified Rankin Scale scores 3-6 despite successful recanalization). RESULTS: A total of 246 patients met the inclusion criteria. Patients in the highest tertile of SHR were significantly more likely to suffer futile recanalization compared with those in the lowest tertile [adjusted OR (aOR) = 3.56, 95%CI = 1.73-7.30, p < 0.001]. The TLC (aOR = 3.38, 95%CI = 1.23-9.27, p = 0.018) was worse in patients with elevated SHR and also acted as an independent predictor of futile recanalization (aOR = 2.31, 95%CI = 1.32-4.05, p = 0.003). Mediation analyses showed that the increased SHR was associated with worse TLC, accounting for 9.7% (95%CI = 1.9%-28.0%) of the harmful effect on futile recanalization. Mediation analyses also indicated a partial mediation effect of the baseline larger ischemic core (effect value = 13.5%, 95%CI = 3.1%-32.0%). CONCLUSION: An increased SHR is correlated with unfavorable TLC and is associated with futile recanalization after EVT. Future prospective studies should independently validate our findings.