Introduction. Modern cardiology and neurovascular surgery are increasingly using minimally invasive X-ray endovascular methods. For an elderly patient, even a gentle intervention is a powerful stressor. If age is combined with overweight, a unique "metabolic background" is formed, potentiating the response to acute stress reaction. X-ray endovascular intervention can be considered not only as a therapeutic procedure, but also as a controlled model of acute stress, allowing to study the reserves of the body. Purpose. To study the features of acute stress response during X-ray endovascular interventions in elderly patients with overweight and to evaluate the possibility of using X-ray endovascular intervention as a clinical model for studying stress-limiting systems of the body. Materials and methods. The study was conducted as a prospective, single-center, observational study. The aim was to characterize the neurohormonal, inflammatory, and hemodynamic response to рентгенэндоваскулярноевмешательство (РЭВ) in patients aged ≥65 years with overweight (BMI 25.0–29.9 kg/m²). All participants signed an informed consent form. Results and discussions. The article analyzes endovascular intervention (EVI) as a clinical model of acute stress in a comorbid group of elderly patients with overweight. It examines the pathophysiological mechanisms of the stress response, the features of neurohormonal, inflammatory, and hemostatic reactions during EVI. The article discusses the impact of age-related changes and increased body mass index (BMI) on the severity and outcomes of acute stress. It presents the concept of the "paradox of obesity" and its potential protective effects. It is concluded that REV in overweight elderly individuals is a convenient and clinically relevant model for studying stress-induced disorders and developing perioperative risk stratification. Conclusion. X-ray endovascular intervention is a full-fledged, reproducible, and clinically significant model of acute stress. When combined with advanced age and excess body weight, this model reveals complex interactions between neurohormonal, inflammatory, and metabolic pathways. Despite the potential risks, moderate weight gain in the elderly may exhibit protective effects (the obesity paradox), necessitating a reevaluation of the traditionally negative perception of this anthropometric characteristic. Further studies using RAE as a standard stressor will help personalize the perioperative management of the most vulnerable groups of cardiac patients.