ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Neuroendocrine Science
Impact of stress hyperglycemia mediating tissue-level collaterals on futile recanalization in large vessel occlusion patients
Provisionally accepted
- 1Department of Neurology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 2Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, China, Chongqing, China
- 3Key Laboratory of Major Brain Disease and Aging Research (Ministry of Education), Chongqing Medical University, Chongqing, China, Chongqing, China
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Background: 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: Multicenter retrospective cohort study of consecutive acute ischemic stroke due to large vessel occlusion patients (AIS-LVO) receiving endovascular treatment (EVT). Included patients had baseline glucose/HbA1c measurements and cerebral perfusion imaging. TLC were measured using the hypoperfusion intensity ratio (HIR, volume ratio of brain tissue with [Tmax>10s/Tmax>6 s]). SHR is calculated by blood glucose (mmol/L)/[(1.59×HbA1C(%) - 2.59]. Using multivariable regression and mediation analyses, we determined the association among SHR, TLC status and futile recanalization (90-day modified Rankin Scale score 3-6 despite successful recanalization). Results: Two hundred forty-six patients met 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 increasing SHR was associated with worse TLC accounted 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 baseline larger ischemic core (effect value: 13.5%, 95%CI: 3.1%-32.0%). Conclusion: Increasing SHR correlated with unfavorable TLC and were associated with futile recanalization after EVT. Future prospective studies should independently validate our findings.
Keywords: Stress hyperglycemia ratio, Tissue-level collaterals, Large vessel occlusion, endovascular treatment, futile recanalization
Received: 08 Aug 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Li, Fu, Huang, Liu, Jiang, Wang, Gong, Xu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tao Xu
Yangmei Chen
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