Reclassification and risk stratification of embolic stroke of undetermined source by ASCOD phenotyping

 EXACTLY how is this going to get survivors 100% recovered? After this research what are the next steps to 100% recovery? Don't know or don't have that, then this was fucking useless research. Please explain how your mentors and senior researchers are so clueless about the only goal in stroke; 100% recovery.

Reclassification and risk stratification of embolic stroke of undetermined source by ASCOD phenotyping

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Takao Hoshino, Takafumi Mizuno, Ayako Nishimura, ...

First Published April 14, 2022 Research Article 

https://doi.org/10.1177/17474930221096953

Article information

Abstract

Background:

Vascular diseases underlying stroke, including atherosclerosis, small-vessel disease (SVD), and cardioembolic pathology, can be present in patients with embolic stroke of undetermined source (ESUS), although these are not direct causes of stroke.

Aims:

To describe the frequency and degree of the 3 major diseases using ASCOD phenotyping and to assess their prognostic implications in ESUS.

Methods:

In this prospective observational study, 221 patients with ESUS within 1 week of onset were consecutively enrolled and followed up for 1 year. Vascular diseases associated with stroke were assessed using the ASCOD classification. The primary outcome was a composite of major adverse cardiovascular events (MACEs).

Results:

Among 221 patients, 135 (61.1%), 102 (46.2%), and 107 (48.4%) had any grade of atherosclerosis (A2 or A3), SVD (S3), and cardiac pathology (C2 or C3), respectively. ESUS patients graded as A2 or A3 (i.e., ipsilateral atherosclerotic plaque, contralateral ≥50% stenosis, or aortic arch plaque) were at a significantly higher risk of MACE than those graded as A0 (i.e., no atherosclerotic disease) (adjusted hazard ratio [95% confidence interval], 2.40 [1.01–5.72]). No differences were observed in the event risk between patients with S3 (i.e., magnetic resonance imaging evidence of SVD) and S0 (i.e., no SVD) and between those with C2 or C3 (i.e., presence of any cardiac pathology) and C0 (i.e., no cardiac abnormalities).

Conclusions:

ASCOD grade A2 or A3 was predictive of MACE in ESUS patients. Reclassification of ESUS using ASCOD phenotyping provides important clues for risk prediction and may guide optimal management strategies.

Keywords

ASCOD, Atherosclerosis, Cardioembolism, Embolic stroke of undetermined source, Etiology, Small vessel disease

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