ABSTRACT NUMBER: ESOC2026A2302 ISCHEMIC STROKE IN VERY YOUNG ADULTS IS NOT A BENIGN CONDITION: FUNCTIONAL OUTCOMES AND PREDICTORS OF POOR PROGNOSIS

Abstract Background and aims Ischemic stroke in very young adults is uncommon and often perceived as a benign condition. However, data regarding clinical severity, functional outcomes, and prognostic factors in this population are limited. This study aimed to describe the clinical characteristics, functional outcomes, and unfavorable outcome predictors in patients aged ≤40 years. Methods This retrospective cohort study included patients aged ≤40 years admitted with ischemic stroke in a comprehensive-stroke-center. Baseline characteristics, stroke severity (NIHSS), infarct size, reperfusion therapies, and 90-day functional outcome (mRS) were analyzed. An unfavorable outcome was defined as mRS ≥2. Non-parametric tests were used to compare continuous variables, and chi-square or Fisher’s exact tests were used to compare categorical variables. Predictors of unfavorable outcomes were assessed using multivariate logistic regression. Results Of the 377 young patients with stroke, 88 were very young adults (median age, 32 years; [IQR] 27–36; 52% women). Median NIHSS was 4 (IQR 2–6). Any reperfusion therapy was performed in 13.4% of the patients. Moderate-to-large infarct size was present in 61% of patients. At 90 days, 78% of the patients achieved functional independence, while 22% had an unfavorable outcome. In multivariate analysis adjusted for age and sex, moderate-to-large infarct size was independently associated with unfavorable outcome (aOR, 5.03; 95% CI1.22–20.7). Conclusions One in four patients did not achieve a favorable functional outcome and reperfusion therapies were infrequently used.These findings challenge the concept of stroke as a benign condition and highlight the need for prospective studies specifically designed to guide treatment and recovery strategies in this population. Conflict of interest Nothing to disclose