Atherogenic index of plasma and 90-day functional outcomes after stroke thrombectomy: a prospective study

Introduction Elevated atherogenic index of plasma (AIP), a marker of dyslipidemia and atherosclerosis, has been linked to cardiovascular risk. However, its association with 90-day functional outcomes after mechanical thrombectomy (MT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) is unclear. This study aimed to investigate this relationship. Methods In this prospective cohort study, 189 consecutive AIS-LVO patients undergoing MT were analyzed. AIP was calculated as log(triglyceride/HDL-C). Participants were stratified into quartiles (Q1-Q4). Primary efficacy outcomes were the proportion of mRS 0-1 at 90 days after MT. The secondary outcomes comprised the proportion of mRS 0-2, mRS score at 90 days after MT, and changes of mRS score within 90 days. The safety outcomes were the proportion of intracerebral hemorrhage (ICH). Multivariable logistic regression and restricted cubic spline models were used. Logistic regression and restricted cubic spline models were utilized to evaluate the association between AIP and post-thrombectomy outcomes. Results After full adjustment, higher AIP quartiles were independently associated with lower odds of excellent outcome (Q4 vs. Q1: OR = 0.250, 95% CI: 0.093–0.669) and functional independence (Q4 vs. Q1: OR = 0.197, 95% CI: 0.075–0.515), showing a dose-response relationship ( P for trend < 0.001). Continuous AIP levels were non-linearly associated with decreasing probability of favorable outcomes. There was no significant association between AIP quartiles and ICH risk ( P > 0.05). Discussion Higher AIP levels are independently associated with poorer 90-day functional outcomes, but not with increased hemorrhage risk, in AIS-LVO patients after MT. AIP may serve as a useful prognostic biomarker to guide post-thrombectomy management.