ABSTRACT Background and Purpose Stress hyperglycemia (SH) is prevalent in patients with acute ischemic stroke (AIS). The stress hyperglycemia ratio (SHR), calculated as the fasting blood glucose (FBG)/glycosylated hemoglobin (HbA1c) ratio, has been widely used to evaluate SH. However, the correlation between SHR and clinical outcomes in AIS patients with large vessel occlusion (LVO) following endovascular treatment (EVT, including mechanical thrombectomy, contact aspiration, intra‐arterial thrombolysis, excluding intravenous thrombolysis) remains unclear. This study aimed to perform a meta‐analysis to investigate the association between SHR and clinical outcomes in EVT‐treated AIS patients with LVO. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, and the Cochrane Library, to identify studies investigating the association between SHR and clinical outcomes. The entire study was executed in strict adherence to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. References were screened based on pre‐specified inclusion and exclusion criteria, and the Newcastle–Ottawa Scale (NOS) was rigorously applied to assess potential bias risks in the selected studies. RevMan 5.3 software was utilized for performing meta‐analyses on the included literature. Results: A total of 10 studies met the inclusion criteria, and 3646 AIS patients who underwent EVT were included in this analysis. The meta‐analysis results demonstrated a higher SHR was associated with an increased risk of poor outcomes (modified Rankin Scale mRS 3–6) at 90 days (odds ratio OR = 2.65, 95% CI: 2.30–3.06, p < 0.001), mortality (OR = 2.62, 95% CI: 1.81–3.79, p < 0.001), intracranial hemorrhage (ICH) (OR = 1.53, 95% confidence interval CI: 1.27–1.85, p < 0.001), symptomatic intracranial hemorrhage (sICH) (OR = 2.05, 95% CI: 1.27–3.30, p < 0.003) after EVT. Conclusion A higher SHR may increase the occurrence of poor outcomes, mortality, ICH, and sICH in AIS patients caused by LVO after EVT. SHR is associated with poor prognosis in AIS patients caused by LVO after EVT.
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