ABSTRACT NUMBER: ESOC2026A2452 GENDER-SPECIFIC FEATURES OF ISCHEMIC STROKE IN MIDDLE-AGED AND ELDERLY PATIENTS: RISK FACTORS, SUBTYPES, AND EARLY OUTCOMES

Abstract Background and aims Gender differences in stroke are well-established. This study aimed to analyze gender-specific features of vascular risk factors, stroke subtypes, and early functional outcomes in middle-aged and elderly patients with acute ischemic stroke in the carotid artery system. Methods In an observational study of 256 patients (167 men, 89 women) aged 46-75 with acute carotid system ischemic stroke, we performed clinical evaluation (NIHSS), neuroimaging, ultrasonography, and laboratory tests. Functional outcomes (modified Rankin Scale) were assessed at premorbid baseline and 30 days post-stroke. Stroke subtypes were determined via TOAST criteria. Results Men presented a more atherogenic risk profile, with higher rates of smoking (39.5% vs. 15.6%, p<0.001), prior stroke (25.7% vs. 14.3%, p=0.042), and significant (>50%) carotid stenosis (30.3% vs. 17.1%). Consequently, atherothrombotic stroke was more frequent in men (27.5% vs. 16.1%, p=0.023), leading to higher rates of moderate-to-severe disability (mRS ≥3) at 21 days compared to women (40.3% vs. 13.7%). In contrast, elderly women had higher rates of hypercholesterolemia (78.6% vs. 58.5%, p=0.006) and a higher frequency of lacunar stroke (30.8% vs. 14.8%, p=0.013), which was associated with poorer functional outcomes than in men (mRS ≥3: 48.1% vs. 31.9%). Conclusions Significant gender dimorphism exists in the risk profiles, pathophysiology, and early outcomes of ischemic stroke. Men are at higher risk for adverse functional outcomes from atherothrombotic stroke, while elderly women face greater disability from lacunar stroke. These findings underscore the necessity of gender-specific strategies, necessitating aggressive atherothrombotic risk management in men and focused attention on drivers of poor outcomes in lacunar stroke among women. Conflict of interest Kostiantyn Stepanchenko and Alla Zhidkova nothing to disclose