2010 Stockholm
MG Hennerici
Joint Symposium
2010 Stockholm
Traditional classifications
Harvard Stroke Data Bank HSDB
Trial of Org 10172 in Acute Stroke Treatment TOAST
Lausanne Registry LR
Genic Classification GC
Oxfordshire Classification
Recent classification
PERFORM classification
SSS-TOAST/Martinos Platform
A-S-C-O
60 yr m
a)
c)
b)
d)
Occlusion ICA l
Large-artery atherosclerosis
Cardioembolism
Small-vessel occlusion
Stroke of other determined etiology
Stroke of undetermined etiology
Adams HP, Bendixen BH, Kapelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of
subtype of acute ischmemic stroke. Definitions for use in a multicenter clinical trial. Stroke
1993;24:1801-4
58 yr m
MCA territory stroke PWI>DWI ICA occlusion
acute stroke with global aphasia and right hemiplegia NIH 15
onset 1 h ago
NVAF treated INR 1.6
Large-artery atherosclerosis
Cardioembolism
Small-vessel occlusion
Stroke of other determined etiology
Stroke of undetermined etiology
Adams HP, Bendixen BH, Kapelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of
subtype of acute ischmemic stroke. Definitions for use in a multicenter clinical trial. Stroke
1993;24:1801-4
A0 S0 C3 O1
Large-artery atherosclerosis
Cardioembolism
Small-vessel occlusion
Stroke of other determined etiology
Stroke of undetermined etiology
Adams HP, Bendixen BH, Kapelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of
subtype of acute ischmemic stroke. Definitions for use in a multicenter clinical trial. Stroke
1993;24:1801-4
THERE
IS A NEED
FOR A BETTER CLASSIFICATION
OF STROKE SUBTYPES
WITH REGARD TO
PHENOMENOLOGY
ETIOLOGY
DEGREE OF CAUSALITY
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of Stroke
Subtypes. Cerebrovasc Dis 2009. 27(5):493-501
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to Stroke
Subtyping: The A-S-C-O (Phenotypic) Classification of Stroke. Cerebrovasc Dis 2009. 27(5):502-508
Anticoagulation recommended A2 S0 C1 O0
A0 S3 C1 O0
Watershed
infarction?
lacunar
infarction?
= undetermined
ASCO: A1 S1 C3 O0
DWI
FLAIR
6 points
Both are unable to predict the individual stroke risk and may
only be used as rough estimates for recommendations
New questions
New questions
Endpoint
AF no abl.
No AF
AF abl.
AD
0.9%
0.5%
0.2% p<0.001
Other D
1.7%
0.7%
0.4% p<0.001
Mortality
23.5%
8.7%
6.0% p<0.001
Stroke
4.7%
2.4%
2.2% p<0.001
4.85%
29.13%
25.73%
C1+
66.02%
26.70%
40.29%
2.43%
C1
4.85%
C+L+S
C+S
C+L
26.70%
C
40.29%
Thank you