ABSTRACT NUMBER: ESOC2026A776 TRIGLYCERIDE-GLUCOSE INDEX IS INDEPENDENTLY ASSOCIATED WITH INTRACRANIAL ATHEROSCLEROTIC DISEASE-RELATED LARGE VESSEL OCCLUSION

Abstract Background and aims Large vessel occlusion (LVO) in acute ischemic stroke can result from intracranial atherosclerotic disease (ICAD). Plaque instability, including intraplaque hemorrhage or local thrombus formation, is thought to contribute to LVO onset; however, early-phase pathophysiology remains unclear. We investigated the association between ICAD-related LVO (ICAD-LVO) and dyslipidemia, a known contributor to plaque instability. Methods We analyzed a prospectively maintained multicenter stroke registry. Among 3,058 consecutive stroke patients admitted between October 2017 and March 2025, those who underwent mechanical thrombectomy for LVO were included. ICAD-LVO was defined as residual stenosis ≥50% at the occlusion site after treatment. Based on admission levels of LDL, TG, HDL, and fasting plasma glucose (FPG), we calculated the TG/HDL ratio, LDL/HDL ratio, atherogenic index of plasma (AIP), and the triglyceride–glucose (TyG) index. Multivariate analysis was performed to identify lipid indices associated with ICAD-LVO. Results A total of 256 patients (60% men; median age 77 years; median NIHSS 19) were included, of whom 34 (13.3%) had ICAD-LVO. Compared with non-ICAD-LVO patients, those with ICAD-LVO had higher TG levels (104 [IQR 81–142] vs 90 [68–132], P=0.039). The TyG index tended to be higher (8.9 [8.5–9.2] vs 8.6 [8.3–9.2], P=0.053), while other lipid indices showed no significant differences. In multivariate analysis, the TyG index was independently associated with ICAD-LVO (OR 2.02, P=0.045). Conclusions A higher TyG index was independently associated with ICAD-LVO, supporting its role as a marker of plaque instability in acute LVO. Conflict of interest All of authors: nothing to disclose