Proposal for the Ischemic Stroke Phenotyping System 2025: ISPS25.

Area of Science:

• Neurology
• Cardiology
• Genetics

Background:

• Established ischemic stroke classification systems require updates due to new etiological insights and diagnostic advancements.
• Recent discoveries include novel mechanisms like carotid artery webs and effective treatments such as patent foramen ovale closure.
• Evolving diagnostic tools, like prolonged outpatient cardiac monitoring, necessitate a revised classification framework.

Purpose of the Study:

• To propose a comprehensive, practical, and generalizable diagnostic evaluation and checklist for ischemic stroke patients.
• To facilitate the identification of definite, probable, or possible etiological mechanisms.
• To enhance secondary stroke prevention strategies and guide targeted treatments and clinical trials.

Main Methods:

• Development of an expanded diagnostic evaluation checklist for ischemic stroke.
• Categorization of stroke mechanisms into cardioembolism, large artery atherosclerosis, small vessel disease, and other determined causes.
• Reclassification of patients based on a more thorough etiological workup.

Main Results:

• The proposed system offers a more comprehensive diagnostic approach compared to existing methods.
• It enables reclassification of ischemic stroke patients based on identified etiological mechanisms.
• The framework supports improved secondary stroke prevention and personalized treatment strategies.

Conclusions:

• An updated ischemic stroke classification system is crucial for integrating recent scientific advancements.
• The proposed diagnostic checklist enhances etiological workup, leading to better patient stratification.
• This revised framework holds potential for improving secondary stroke prevention and advancing clinical research in ischemic stroke.