Glycemic gap vs stress hyperglycemic ratio: a comparative assessment of their predictive roles of leptomeningeal collateral circulation and clinical outcomes in acute ischemic large vessel occlusion.

OBJECTIVE

To evaluate the association of glycemic gap (GG) and stress hyperglycemia ratio (SHR) with leptomeningeal collateral circulation (LMC) and 90-day functional outcomes in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO).

BACKGROUND

Stress hyperglycemia (SH) has been associated with poor collateral circulation, larger infarct volume, and worse stroke outcomes, particularly in LVO. Different metrics exist to quantify SH, but their direct correlation with collateral status remains unclear.

METHODS

In this retrospective single-center study, we included patients with AIS due to anterior circulation LVO. SH was assessed using two metrics: GG, defined as Admission Blood Glucose (mg/dL) - (28.7 × HbA1c - 46.7), and the SHR, calculated as Admission Blood Glucose / [28.7 × HbA1c) - 46.7]. CTA-based collateral scores were classified into three categories-malignant, intermediate, and symmetric-based on the Regenhardt et al. system. Ninety-day modified Rankin Scale (mRS) scores were dichotomized into good (0-2) and poor (3-6) outcomes.

RESULTS

A total of 267 patients (54.3 % male) were included. Higher GG and SHR were significantly associated with worse collateral scores on CTA (P < 0.01). SHR was significantly associated with poor 90-day functional outcomes measured by mRS (P < 0.01; OR 6.6, 95 % CI: 1.8-24), while GG showed a nonsignificant trend (P = 0.07; OR 1.0, 95 % CI: 0.9-1.1).

CONCLUSION

Elevated SHR and GG are associated with poorer leptomeningeal collaterals in patients with LVO. SHR, in particular, demonstrates a stronger and statistically significant association with worse 90-day functional outcomes.