Association Between the High Stress Hyperglycemia Ratio and Outcomes of Mechanical Thrombectomy: A Systematic Review and Meta-Analysis.

Abstract

Stroke is a major cause of global death and disability, with mechanical thrombectomy (MT) as the gold standard treatment for large vessel occlusion. The stress hyperglycemia ratio (SHR), which accounts for long-term glycemic control via glycated hemoglobin (HbA1c), is a promising predictor of stroke outcomes. However, its prognostic value in acute ischemic stroke (AIS) patients treated with MT has not been systematically evaluated. We conducted a meta-analysis to assess the association between SHR and outcomes after MT. PubMed, Embase, Cochrane Library, and Google Scholar were searched. Analyzed outcomes included functional outcomes, mortality, early neurological deterioration (END), and symptomatic intracranial hemorrhage (sICH). Data were pooled using random-effects models, with heterogeneity assessed by I² statistics. High SHR was significantly associated with increased 90-day poor outcomes (OR=2.98; 95% CI: 1.89-4.71; p<0.0001), low 90-day good outcomes (OR=0.43; 95% CI: 0.32-0.59; p<0.0001), increased 90-day mortality (OR=2.06; 95% CI: 1.37-3.11; p=0.0005), higher risk of END (OR=6.27; 95% CI: 3.22-12.24; p<0.0001), and sICH (OR=2.53; 95% CI: 1.73-3.70; p<0.0001). Elevated SHR predicts poor outcomes, higher mortality, and more complications in AIS patients undergoing MT, highlighting its importance in stroke management.