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Original article
Phenotypic ASCOD characterisations of ischaemic stroke in the young at an urban tertiary care centre
  1. Angela Liu1,
  2. Mohsen Pirastehfar2,
  3. Daohai Yu3,
  4. Guillermo Linares4
  1. 1 Department of Neurology, Washington University in St Louis, Saint Louis, Missouri, USA
  2. 2 Department of Vascular Neurology, UC San Diego, La Jolla, California, USA
  3. 3 Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
  4. 4 Department of Stroke and Neurocritical Care, University of Vermont College of Medicine, Burlington, Vermont, USA
  1. Correspondence to Dr Angela Liu; liu.a{at}wustl.edu

Abstract

Background and purpose Stroke in young individuals is a serious public health burden. This study aimed to characterise the various phenotypes of ischaemic stroke in a young urban population (≤50 years old) using the ASCOD classification system, which assigns a score to five stroke categories: atherosclerosis, small vessel disease (SVD), cardioembolism, other and dissection. Within each category, a numerical score represents the degree of causality attributed to the stroke.

Methods This retrospective study cohort was composed of patients from an urban tertiary care academic centre. Cases were selected by searching Get With the Guidelines database for adults ≤50 years old with ischaemic stroke. The study sample included 175 ischaemic strokes in 157 patients, with 16 subjects re-infarcting. Using retrospective chart review, each stroke was scored according to the ASCOD classification system. Multivariable logistic regression analyses were performed to explore each ASCOD category’s association with causal risk factors.

Results Of possible causal mechanisms, defined as receiving a grade 1 or 2, a cardiovascular aetiology was most prevalent (25.7%), followed by SVD (22.3%), and closely by atherosclerosis (21.1%). Of general phenotypes, defined as receiving a grade 1 or 2 or 3, atherosclerosis was the most prevalent (51.4%), followed by SVD (47.4%), cardioembolism (42.3%) and other (35.4%). 31.6% of all strokes were of unclear aetiology. Subjects between 45 and 50 years old were more likely to develop a cardioembolic or SVD stroke when compared with subjects <45 years old.

Conclusion This study took a novel approach to ASCOD phenotyping, allowing several observations: (1) In patients with advanced atherosclerosis receiving the score A1, the vast majority had systemic atherosclerosis in multiple vascular territories; (2) the cardiac score C2(6), defined as a radiographic pattern highly suggestive of a central embolic source, may overestimate the prevalence of true cardiac disease; (3) incidental laboratory findings may detect some underlying pathology, but causality to the stroke is unlikely.

  • atherosclerosis
  • stroke
  • embolic
  • statistics

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2017-000139

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    Footnotes

    • Contributors MP conceived the project and implemented data collection tools and performed the initial data collection. AL and GL organised the data, performed ASCOD scoring, drafted and revised the paper. DY helped build statistical models for data analysis and interpretation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.