Stroke Classification

Caplan, Louis R.

doi:10.1161/strokeaha.110.594630

Cited by 22 publications

(14 citation statements)

References 27 publications

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“…The Harvard Cooperative Stroke Registry, the first published database on any medical condition, classified patients by clinical findings. Only 45% of patients received conventional angiography, and 3% underwent computerized tomography (CT) 29. Nevertheless, the findings were comparable to previous registry studies based on postmortem data 30.…”

Section: Previous Classificationssupporting

confidence: 81%

Ischemic Stroke Subtype Classification: An Asian Viewpoint

2014

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Proper classification of the causative mechanism of stroke is important for optimizing stroke treatment and assessing prognosis. The primary etiology of stroke differs according to race and ethnicity: emboli originating from the heart or extracranial large arteries are common in Western populations, whereas small-vessel occlusion or intracranial atherosclerosis is more prevalent in Asians. Intracranial atherosclerosis frequently leads to stroke by branch-artery occlusion, and the degree of stenosis in these cases is often <50%. Mild intracranial atherosclerotic stenosis may cause distal embolization, if the atherosclerotic plaque is sufficiently vulnerable. Moreover, high-resolution magnetic resonance imaging studies have identified small plaques causing infarction, even in patients with normal-appearing vascular findings. Such cases, which are prevalent in Asia, could not be classified as large-artery atherosclerosis by previous classification systems. Additionally, single subcortical infarctions, which are usually attributed to lipohyalinotic small-vessel disease, can have other causes, including microatheroma of perforators and atherothrombotic lesions at the parental artery. Single subcortical infarctions associated with parental artery disease or those bordering on the main vessel more often have atherosclerotic characteristics than do those associated with lipohyalinosis of the penetrating artery. In countries where intracranial atherosclerosis is common, such atherosclerotic single subcortical infarctions are predicted to be prevalent. These cases, however, could not be appropriately classified in previous systems. Further effort should be devoted to formulate ischemic stroke classification systems that adequately incorporate results of recent studies and reflect the underling pathologic mechanisms, especially in patients with single subcortical infarction and intracranial atherosclerosis.

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Section: Previous Classificationssupporting

confidence: 81%

Ischemic Stroke Subtype Classification: An Asian Viewpoint

2014

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“…In 1978, the Harvard Cooperative Stroke Registry classification was introduced, at a time when only 3% of patients were assessed with CT [2,3]. This classification was replaced in 1988 by the Stroke Data Bank classification system, by which point 97% of patients received CT, and the pathogenesis of ischemic stroke subtypes was better understood [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…This classification was replaced in 1988 by the Stroke Data Bank classification system, by which point 97% of patients received CT, and the pathogenesis of ischemic stroke subtypes was better understood [3,4]. MRI and echocardiography were then added to the assessment procedures.…”

Section: Introductionmentioning

confidence: 99%

SPARKLE (Subtypes of Ischaemic Stroke Classification System), Incorporating Measurement of Carotid Plaque Burden: A New Validated Tool for the Classification of Ischemic Stroke Subtypes

et al. 2014

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Background: Previous classification systems of acute ischemic stroke (Causative Classification System, CCS, of acute ischemic stroke, Trial of Org 10172 in Acute Stroke Treatment, TOAST) established the diagnosis of large artery disease (LAD) based on the presence or absence of carotid stenosis. However, carotid plaque burden is a stronger predictor of cardiovascular risk than stenosis. Our objective was to update definitions of ischemic stroke subtypes to improve the detection of LAD and to assess the validity and reliability of a new classification system: SPARKLE (Subtypes of Ischaemic Stroke Classification System). Methods: In a retrospective review of clinical research data, we compared three stroke subtype classifications: CCS, TOAST and SPARKLE. We analyzed a random sample of 275 patients presenting with minor stroke or transient ischemic attack (TIA) in an Urgent TIA Clinic in London, Ont., Canada, between 2002 and 2012. Results: There was substantial overall agreement between SPARKLE and CCS (κ = 0.75), with significant differences in the rate of detection of LAD, cardioembolic and undetermined causes of stroke or TIA. The inter-rater reliability of SPARKLE was substantial (κ = 0.76) and the intra-rater reliability was excellent (κ = 0.91). Conclusion: SPARKLE is a valid and reliable classification system, providing advantages compared to CCS and TOAST. The incorporation of plaque burden into the classification of LAD increases the proportion of cases attributable to LAD and reduces the proportion classified as being of 'undetermined' etiology.

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“…The Harvard Cooperative Stroke Registry was the first computer-based diagnostic program using a prospective published database for stroke subclassification [3]. With only 3% had CT scans, the diagnosis of stroke in half of those patients was based on clinical information; the others were diagnosed by cerebral angiography [4]. Patients studied in the Harvard Stroke Registry were predominantly white and from a single institution.…”

Section: Introductionmentioning

confidence: 99%

Classifying Ischemic Stroke, from TOAST to CISS

Chen

Gao

Wang

et al. 2012

CNS Neuroscience & Therapeutics

108

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SUMMARYIschemic stroke classification is critical in conducting basic research and clinical practice. A precise analysis of stroke subtypes requires the integration of clinical features, findings from diagnostic tests, and knowledge about potential etiologic factors by competent diagnostic investigators. We performed a literature review of the published stroke classification systems and examined each for its benefits and limitations in the evaluation of the stroke etiology. Two major approaches to etiologic classifications of ischemic stroke are currently being used: the causative and phenotypic subtyping. The most widely used causative system is the Trial of Org 10172 in acute stroke treatment (TOAST) classification. With the advances in modern diagnostic technology, new stroke subclassification systems, such as the causative classification system (CCS) and Chinese ischemic stroke subclassification (CISS) system, have been developed to enhance the accuracy of TOAST. The A-S-C-O (Atherosclerosis, Smallvessel disease, Cardiac source, Other cause) phenotypic classification system makes efforts to identify the most likely etiology but not neglecting the possibility of other potential multiple causes. We conclude that the ideal stroke classification system needs to be valid, easy to use, evidence-based, and incorporate new information as it emerges.

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Stroke Classification

Cited by 22 publications

References 27 publications

Ischemic Stroke Subtype Classification: An Asian Viewpoint

Ischemic Stroke Subtype Classification: An Asian Viewpoint

SPARKLE (Subtypes of Ischaemic Stroke Classification System), Incorporating Measurement of Carotid Plaque Burden: A New Validated Tool for the Classification of Ischemic Stroke Subtypes

Classifying Ischemic Stroke, from TOAST to CISS

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