ABSTRACT NUMBER: ESOC2026A1895 IMPACT OF IRON DEFICIENCY ON INFARCT GROWTH, HYPOPERFUSION SEVERITY, AND CLINICAL OUTCOME IN ACUTE ISCHEMIC STROKE

Abstract Background and aims Iron deficiency (ID) is associated with worse functional outcomes. The mechanisms underlying this relationship remain unclear. ID may impair microvascular function, potentially affecting cerebral perfusion. We aimed to investigate the association between ID and infarct progression in acute ischemic stroke. Methods We conducted a two-year retrospective observational study including consecutive patients with acute ischemic stroke. All underwent CT or MR perfusion imaging at admission and after 24 hours. ID was defined as ferritin<100 ng/ml or 100-299 ng/ml with transferrin saturation TSAT<20%. Perfusion parameters included ischemic core volume (CBF < 30%), hypoperfusion intensity ratio (HIR, Tmax>10s/Tmax>6 s), and infarct growth rate (IGR, ischemic core volume divided by onset-to-imaging time). Correlations between TSAT and perfusion metrics were adjusted for age and sex. Clinical outcomes included NIHSS, mRS, and hemorrhagic transformation. Results Among 382 patients (median age 76 years; 44.2% women), 58.8% had ID. Patients with ID showed significantly higher infarct growth (IGR 0.81 vs 0.44; P = 0.034). TSAT correlated inversely with IGR (r = −0.136, P = 0.035; 95% CI −0.258 to −0.010) and HIR (r = −0.213, P = 0.005; 95% CI −0.352 to −0.064). These associations remained significant after adjustment for age and sex. Clinically, patients with ID had higher NIHSS scores and worse functional outcomes at discharge and at 90 days. Conclusions ID in acute ischemic stroke is associated with accelerated infarct growth, more severe hypoperfusion patterns, and poorer neurological outcomes, supporting a potential pathophysiological role of iron status in infarct evolution and prognosis. Conflict of interest The authors declare no conflicts of interest.