The relationship between ischemic stroke secondary symptomatic carotid stenosis and triglyceride-glucose index

Objective: Ischemic stroke is an important cause of death and disability. Symptomatic ICA stenosis caused by atherosclerotic carotid plaques is an important goal in stroke prevention. Just like HT, DM, smoking; IR is also an important risk factor and the relationship between the new IR predictor called "TyG index" and atherosclerosis has been shown in studies. In our study, we aimed to determine whether there is a correlation between the TyG index and strokes due to symptomatic ICA stenosis and due to other etiologies. Materials and Method: 360 patients who underwent DSA in our center due to ischemic stroke between 2014 and 2022 were analyzed retrospectively and divided into two groups. Patients with ≥50% symptomatic carotid stenosis were included in the first group (n=202), and patients with all other etiologies were in the second group (n=158). The patients were evaluated in terms of laboratory parameters, medical and family history, tobacco usage, stenosis percentage, acute stroke and TOAST classification. Results: Groups were similar in terms of age and gender. HDL was found 39,72±9,4 in group 1 and 42,37±10,84 in group 2 (p=0,014); TC/HDL was found 5,06±1,53 in group 1 and 4,7±1,27 in group 2 (p=0,019); TG was found 168,69±93,87 in group 1 and 139,34±79,69 in group 2 (p=0,002). TyG index was found 9,06±0,6 in group 1 and 8,87±0,62 in group 2 (p=0,003). Comparing those with ≥70% stenosis on DSA with <50% stenosis, median (min-max) values were LDL/HDL 3.2 (0.9-9.9) in group 1, 3 (1.3- 9.4 in group 2) ) (p=0.131); TC/HDL 4.9 (2.5-12.9) in group 1, 4.7 (2.3-12) in group 2 (p=0.024); TG 155 (46-631) in group 1, 139.8 ± 79.6 in group 2 (p<0.001); TyG index was 9 (7.7 - 10.9) in group 1, 8.8 (7.7 - 11.2) in group 2 (p=0.002); HDL was 39 (14 - 77) in group 1 and 40.9 (19 - 81.5) in group 2 (p=0.038). A cut-off value of 8.976 can be taken to determine the relationship between stroke due to symptomatic ICA stenosis and (1)TyG index [AUC 0.603 (95% CI 0.544-0.662); 56.9% sensitivity, 43% specificity, p<0.001]; (2) A cut-off value of 4.866 can be taken to determine the relationship between TC/HDL [EAA 0.568 (95% CI 0.509-0.627); We found a sensitivity of 54.5%, specificity of 45.6%, p=0.026]. Conclusions: The TyG index has a significant effect on symptomatic ICA stenosis, and index follow-up should be considered to prevent early atherosclerosis progression with the management of the TyG index. Keywords: carotid stenosis, triglyceride-glucose index, ischemic stroke, digital substraction angiography, atherosclerosis