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Published on: June 2, 2023
Overlap of diseases underlying ischemic stroke: the ASCOD phenotyping
Gaia Sirimarco1, Philippa C Lavallée, Julien Labreuche
1Paris-Diderot University, Sorbonne Paris Cité, Paris, France.
Insights
ASCOD phenotyping reveals significant overlap between atherosclerosis, cardiac pathology, and small vessel disease in ischemic stroke patients. Controlling atherosclerotic risk factors is crucial for all stroke patients due to high disease prevalence.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Diagnostics
Background:
- Ischemic stroke often results from multiple underlying vascular diseases.
- The Atherosclerotic, Small vessel disease, Cardiac pathology, Other causes, and Dissection (ASCOD) phenotyping system categorizes stroke etiologies.
- Understanding disease overlap and prognostic implications is vital for effective stroke management.
Purpose of the Study:
- To apply ASCOD phenotyping to investigate the overlap of vascular diseases in ischemic stroke patients.
- To examine the prognostic implications of these overlapping diseases on long-term vascular event risk.
Main Methods:
- ASCOD phenotyping was applied by a single rater to 405 patients from the Asymptomatic Myocardial Ischemia in Stroke and Atherosclerotic Disease study.
- Patients were assessed for the presence and likelihood of atherosclerosis (A), small vessel disease (S), and cardiac pathology (C).
Main Results:
- Atherosclerosis (A) was present in 90%, cardiac pathology (C) in 52%, and small vessel disease (S) in 66% of patients.
- A significant overlap was observed, with 25% of patients having multiple diseases (grades 1-2) and 80% (grades 1-3).
- Cardiac pathology grades correlated with increased vascular event risk, while any atherosclerosis indicated high risk regardless of its grade.
Conclusions:
- ASCOD phenotyping highlights substantial overlap among atherosclerosis, cardiac pathology, and small vessel disease in ischemic stroke.
- The high prevalence of atherosclerosis underscores the necessity of systematic risk factor control in all ischemic stroke patients.
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 for high risk, regardless the degree of likelihood for A.
Conclusions:
ASCOD phenotyping shows that the large overlap among the 3 main diseases, and the high prevalence of any form of atherosclerotic disease, reinforces the need to systematically control atherosclerotic risk factors in all ischemic strokes.
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