Predictive value of the metabolic score for insulin resistance for neurological outcomes in acute large vessel occlusive stroke patients undergoing mechanical thrombectomy

Objectives: Acute ischemic stroke with large vessel occlusion (AIS-LVO) is associated with high critical illness rates and poor prognosis, and endovascular therapy is crucial for improving outcomes. The metabolic score for insulin resistance (METS-IR) has been linked to stroke incidence and subsequent prognosis. Materials and Methods: This single-center, retrospective observational study enrolled AIS-LVO patients who underwent mechanical thrombectomy with the Niko Reco stent. Baseline data were collected, and serum METS-IR levels at admission were measured for grouping. Multivariate logistic regression analyzed the association between METS-IR and adverse outcomes, hemorrhagic transformation (HT), and early neurological deterioration (END). Receiver operating characteristic curve analysis (through area under the curve) evaluated predictive value, and restricted cubic splines explored dose-response relationships. Results: One hundred and forty-four patients were stratified into four groups by METS-IR. Significant intergroup differences existed in age, gender, body mass index, and metabolic indicators (e.g., blood glucose). The highest METS-IR group had higher diabetes prevalence, elevated National Institutes of Health Stroke Scale scores, and increased rates of poor prognosis, HT, and END. Multivariate logistic regression showed that higher METS-IR was independently associated with increased risks of these adverse events in a dose-dependent manner. Conclusion: For AIS-LVO patients undergoing mechanical thrombectomy, admission serum METS-IR is an independent risk factor for neurological outcomes, HT, and END and exhibits clinical utility in predicting these adverse events.