The ASCOD Phenotyping of Ischemic Stroke (Updated ASCO Phenotyping)

Amarenco, Pierre; Bogousslavsky, Julien; Caplan, Louis R.; Donnan, Geoffrey A.; Wolf, Marc E.; Hennerici, Michael G.

doi:10.1159/000352050

Cited by 307 publications

(240 citation statements)

References 25 publications

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“…The D-dimer level was measured within 24 hours and BNP was measured within 72 hours after admission in all the patients. Furthermore, because stroke etiology other than cardioembolism may be implicated even in the patients with NVAF, we investigated the ASCOD stroke phenotypes in all patients, because such phenotyping takes all the possible stroke etiologies into consideration and is highly recommended in stroke studies (9). The phenotypes were compared between the treatment group and discontinuation group.…”

Section: Methodsmentioning

confidence: 99%

Clinical Features of Ischemic Stroke during Treatment with Dabigatran: An Association between Decreased Severity and a Favorable Prognosis

et al. 2015

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Objective Anticoagulation therapy with warfarin is associated with a favorable prognosis in ischemic stroke. Dabigatran, a new oral anticoagulant, is widely used to prevent ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, its association with decreased severity and a favorable prognosis once ischemic stroke has occurred remains unknown. Methods We retrospectively reviewed all the patients with NVAF-associated ischemic stroke admitted to our hospital from April 2011 to December 2014 and included those who received dabigatran therapy. We assessed whether the patients were under regular use of the drug or discontinuance and classified them into 2 groups, the treatment and discontinuation groups. Clinical data, including the age, sex, ASCOD stroke phenotype, NVAF type, prescribed drug dose, comorbidities, CHADS2 score, renal function, National Institute of Health Stroke Scale (NIHSS) score on admission, modified Rankin scale (mRS) score at discharge, D-dimer, and brain natriuretic peptide, were investigated and compared between the groups. Results Nine patients were under regular dabigatran therapy, and 6 were under discontinuance of the drug. The age, sex, ASCOD stroke phenotype, NVAF type, comorbidities, renal function, and CHADS2 scores did not differ between the 2 groups; however, the NIHSS scores were significantly lower in the treatment group. The mRS scores at discharge were additionally decreased in the treatment group. Moreover, the D-dimer scores were lower in the treatment group, thus suggesting a possible role in the decreased stroke severity. Conclusion Dabigatran may therefore decrease the severity of ischemic stroke, even if ischemic stroke occurs.

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Section: Methodsmentioning

confidence: 99%

Clinical Features of Ischemic Stroke during Treatment with Dabigatran: An Association between Decreased Severity and a Favorable Prognosis

et al. 2015

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“…using the revised version of ASCO classification, named ASCOD. 9 The ASCO classification categorizes 4 predefined phenotypes: atherosclerosis (A), SVD (S), cardiac pathology (C), and other causes (O). Each of the 4 phenotypes is graded according to following categories: 1 when the disease is a potential cause of the index stroke, 2 when causality is uncertain, 3 when the disease is present but is unlikely a direct cause, 0 when the disease is absent, and 9 when the workup is insufficient to rule out the disease.…”

mentioning

confidence: 99%

Overlap of Diseases Underlying Ischemic Stroke

Gaia

Lavallée

Labreuche

et al. 2013

Stroke

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Stroke classification is crucial to perform clinical trials, epidemiological studies, phenotyping for genetic studies, and classify patients to evaluate best treatment strategy. Precise analysis of stroke subtypes requires the integration of clinical features, diagnostic test findings, and knowledge about potential etiologic factors. With improvement of noninvasive brain and cardiovascular imaging, as well as biological tests, the amount of available information is fast increasing. Current classifications only consider the most likely cause, neglecting the overlap between diseases.1,2 Therefore, a patient classified in the atherosclerosis group is rigidly analyzed with this group even if there are MRI or clinical evidence of presence of small vessel disease (SVD) deemed to be not causally related with the index stroke. 3 In this example, any genetic analysis with this kind of classification would, therefore, be biased by neglecting the SVD presence. Furthermore, current diagnostic tools often identify several coexisting causes resulting in ≈40% of ischemic strokes classified as undetermined in causative system. 4,5 The ASCO (atherosclerosis, SVD, cardiac pathology, and other uncommon causes) phenotyping assigned a degree of likelihood on potential causality of all 4 main underlying diseases commonly encountered in ischemic stroke patients. 6 Therefore, the purpose of the ASCO phenotyping is not to reduce the rate of undetermined cause as in causative classifications, 7 because there is no undetermined category in ASCO, but to describe the overlap degree between the diseases.We investigated the overlap of underlying vascular diseases of ischemic stroke in the Asymptomatic Myocardial Ischemia Background and Purpose-ASCOD phenotyping (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; and D, dissection) assigns a degree of likelihood to every potential cause (1 for potentially causal, 2 for causality is uncertain, 3 for unlikely causal but disease is present, 0 for absence of disease, and 9 for insufficient workup to rule out the disease) commonly encountered in ischemic stroke. We used ASCOD to investigate the overlap of underlying vascular diseases and their prognostic implication. Methods-A single rater applied ASCOD in 405 patients enrolled in the Asymptomatic Myocardial Ischemia in Stroke and Atherosclerotic Disease study. Results-A was present in 90% of patients (A1=43% and A2=15%), C in 52% (C1=23% and C2=14%), and S in 66% (S1=11% and S2=2%). On the basis of grades 1 and 2, 25% of patients had multiple underlying diseases, and 80% when all 3 grades were considered. The main overlap was found between A and C; among C1 patients, A was present in 92% of cases (A1=28%, A2=20%, and A3=44%). Conversely, among A1 patients, C was present in 47% of cases (C1=15%, C2=15%, and C3=17%). Grades for C were associated with gradual increase in the 3-year risk of vascular events, whereas risks were similar across A grades, meaning that the mere presence of atherosclerotic disease qualifies f...

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“…The Trial of Org 10172 Acute Stroke Treatment (TOAST) classification distinguishes i) large-artery atherosclerosis, ii) cardio-embolism, iii) small vessel occlusion, iv) stroke of other determined etiology and v) stroke of undetermined etiology as etiological stroke subtypes [25]. The ASCO system (where A stands for atherosclerosis, S for small vessel disease, C for Cardiac source, O for other cause) classifies similar subtypes, though both classification schemes have been found to have different characteristics in practice [26,27]. These classifications enable us to investigate associations between genetic risk loci and stroke subtypes and to enable pooling with data of other ongoing genetic stroke studies [20,21,25,27].…”

Section: Project Descriptionmentioning

confidence: 99%

“…The ASCO system (where A stands for atherosclerosis, S for small vessel disease, C for Cardiac source, O for other cause) classifies similar subtypes, though both classification schemes have been found to have different characteristics in practice [26,27]. These classifications enable us to investigate associations between genetic risk loci and stroke subtypes and to enable pooling with data of other ongoing genetic stroke studies [20,21,25,27]. Second, besides genetic research the Parelsnoer Institute-CVA Study population is also very well suited for epidemiological studies because of its prospective, multicenter design and large sample size [28].…”

Section: Project Descriptionmentioning

confidence: 99%

“…Deficits in neurological examination at baseline are recorded according to the National Institutes of Health Stroke Scale (NIHSS), a graded assessment of consciousness, eye movements, visual fields, motor and sensory impairments, ataxia, speech, cognition and inattention [29]. Ischemic stroke subtype is defined according to both the TOAST classification and the ASCO system [26,27]. Data are collected on treatment such as intravenous thrombolysis, neurosurgical (clipping or decompressive surgery) or endovascular (coiling of aneurysms, intraarterial thrombectomy or thrombolysis) intervention, start of oral anticoagulation treatment in case of atrial fibrillation, and start of secondary prophylactic treatment.…”

Section: Patientsmentioning

confidence: 99%

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