ASCOD classification (ischemic stroke)
Updates to Article Attributes
The ASCOD classification system 1, published in 2013, aims aims to define phenotypes of ischaemic strokes for for individual patients by assigning a degree of probability to each of the most common causes of this pathology.
It serves most strictly as a research tool but is also useful clinically as a mnemonic to consider common causes of ischaemic stroke.
Compared to alternative classification systems that assign only one cause to each individual stroke and often have an "undefined" category, the ASCOD system allows classification of each stroke by detailing multifactorial causes and their relative probability of causation.
Classification
The ASCOD classification, not fully detailed here, offers offers objective criteria for each of the following diseases based on imaging, laboratory and clinical evaluations:
-
atherosclerosis/atherothrombosis
includes criteria such as stenosis >50% of an artery supplying the ischaemic territory, endoluminal thrombus or occlusion
-
small-vessel disease
includes criteria such as lacunar infarcts, leukoaraiosis and microbleeds
-
cardiac pathology
includes findings such as mitral stenosis, recent myocardial infarction, documented atrial fibrillation, endocarditis
-
other causes
amongst others:
dolichoectasiadolichoectasia with complicated aneurysm,systemic lupus,antiphospholipidantiphospholipid antibody syndrome,sickle cell disease,moyamoya disease
-
dissection
ideally documented with MRI or CT
Grading
For each letter in the system, a grade is assigned:
1:
thethe disease is present and can potentially be a cause2:
thethe disease is present, but the causal link is uncertain3:
thethe disease is present, but the causal link is unlikely0:
thethe disease is absent9: the workup is insufficient to grade the disease
History and etymology
The currentASCOD classification replaces the ASCO classification 2 published published in 2009, with the addition of the letter "D" to take into account the importance of arterial dissection in in the genesis of ischaemic stroke, particularly in young patients.
-<p>The <strong>ASCOD</strong> classification system <sup>1</sup>, published in 2013, aims to define phenotypes of <a href="/articles/ischaemic-stroke">ischaemic strokes</a> for individual patients by assigning a degree of probability to each of the most common causes of this pathology.</p><p>It serves most strictly as a research tool but is also useful clinically as a mnemonic to consider common causes of ischaemic stroke.</p><p>Compared to alternative classification systems that assign only one cause to each individual stroke and often have an "undefined" category, the ASCOD system allows classification of each stroke by detailing multifactorial causes and their relative probability of causation.</p><h4>Classification</h4><p>The ASCOD classification, not fully detailed here, offers objective criteria for each of the following diseases based on imaging, laboratory and clinical evaluations:</p><ul>- +<p>The <strong>ASCOD classification</strong> system <sup>1</sup>, published in 2013, aims to define phenotypes of <a href="/articles/ischaemic-stroke">ischaemic strokes</a> for individual patients by assigning a degree of probability to each of the most common causes of this pathology.</p><p>It serves most strictly as a research tool but is also useful clinically as a mnemonic to consider common causes of ischaemic stroke.</p><p>Compared to alternative classification systems that assign only one cause to each individual stroke and often have an "undefined" category, the ASCOD system allows classification of each stroke by detailing multifactorial causes and their relative probability of causation.</p><h4>Classification</h4><p>The ASCOD classification, not fully detailed here, offers objective criteria for each of the following diseases based on imaging, laboratory and clinical evaluations:</p><ul>
-<strong>a</strong>therosclerosis/atherothrombosis<ul><li>includes criteria such as stenosis >50% of an artery supplying the ischaemic territory, endoluminal thrombus or occlusion</li></ul>- +<p><strong>a</strong>therosclerosis/atherothrombosis</p>
- +<ul><li><p>includes criteria such as stenosis >50% of an artery supplying the ischaemic territory, endoluminal thrombus or occlusion</p></li></ul>
-<strong>s</strong>mall-vessel disease<ul><li>includes criteria such as <a href="/articles/lacunar-infarct">lacunar infarcts</a>, <a href="/articles/leukoaraiosis">leukoaraiosis</a> and <a href="/articles/cerebral-microhaemorrhage">microbleeds</a>-</li></ul>- +<p><strong>s</strong>mall-vessel disease</p>
- +<ul><li><p>includes criteria such as <a href="/articles/lacunar-infarct">lacunar infarcts</a>, <a href="/articles/cerebral-small-vessel-disease">leukoaraiosis</a> and <a href="/articles/cerebral-microhaemorrhage">microbleeds</a></p></li></ul>
-<strong>c</strong>ardiac pathology<ul><li>includes findings such as <a href="/articles/mitral-valve-stenosis-1">mitral stenosis</a>, recent <a href="/articles/myocardial-infarction">myocardial infarction</a>, documented atrial fibrillation, <a href="/articles/infective-endocarditis">endocarditis</a>-</li></ul>- +<p><strong>c</strong>ardiac pathology</p>
- +<ul><li><p>includes findings such as <a href="/articles/mitral-valve-stenosis-1">mitral stenosis</a>, recent <a href="/articles/myocardial-infarction">myocardial infarction</a>, documented atrial fibrillation, <a href="/articles/infective-endocarditis">endocarditis</a></p></li></ul>
-<strong>o</strong>ther causes<ul><li>amongst others: dolichoectasia with complicated aneurysm, <a href="/articles/systemic-lupus-erythematosus-cns-manifestations">systemic lupus</a>, antiphospholipid antibody syndrome, <a href="/articles/sickle-cell-disease">sickle cell disease</a>, <a href="/articles/moyamoya-disease-1">moyamoya disease</a>-</li></ul>- +<p><strong>o</strong>ther causes</p>
- +<ul><li><p>amongst others: dolichoectasia with complicated aneurysm, <a href="/articles/systemic-lupus-erythematosus-cns-manifestations">systemic lupus</a>, antiphospholipid antibody syndrome, <a href="/articles/sickle-cell-disease">sickle cell disease</a>, <a href="/articles/moyamoya-disease-1">moyamoya disease</a></p></li></ul>
-<strong>d</strong>issection<ul><li>ideally documented with MRI or CT</li></ul>- +<p><strong>d</strong>issection</p>
- +<ul><li><p>ideally documented with MRI or CT</p></li></ul>
-<li>1: the disease is present and can potentially be a cause</li>-<li>2: the disease is present, but the causal link is uncertain</li>-<li>3: the disease is present, but the causal link is unlikely</li>-<li>0: the disease is absent</li>-<li>9: the workup is insufficient to grade the disease</li>-</ul><h4>History</h4><p>The current classification replaces the ASCO classification <sup>2</sup> published in 2009 with the addition of the letter "D" to take into account the importance of <a href="/articles/arterial-dissection">arterial dissection</a> in the genesis of ischaemic stroke, particularly in young patients.</p>- +<li><p>1: the disease is present and can potentially be a cause</p></li>
- +<li><p>2: the disease is present, but the causal link is uncertain</p></li>
- +<li><p>3: the disease is present, but the causal link is unlikely</p></li>
- +<li><p>0: the disease is absent</p></li>
- +<li><p>9: the workup is insufficient to grade the disease</p></li>
- +</ul><h4>History and etymology</h4><p>The ASCOD classification replaces the ASCO classification <sup>2</sup> published in 2009, with the addition of the letter "D" to take into account the importance of <a href="/articles/arterial-dissection">arterial dissection</a> in the genesis of ischaemic stroke, particularly in young patients.</p>