Ischemic stroke classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]Seyedmahdi Pahlavani, M.D. [3]Aysha Anwar, M.B.B.S[4],Tarek Nafee, M.D. [5],Sara Mehrsefat, M.D. [6]

Overview

Ischemic stroke may be classified according to the duration of onset of symptoms and causative agent. The major classification system of ischemic stroke include toast classification system, causative classification of stroke system (CCS), and sparkle classification of ischemic stroke.

Classification

Ischemic stroke may be classified according to the duration of onset of symptoms and causative agent. The major classification system of ischemic stroke include: [1][2][3][4][5][6][7]

  • Toast classification system[1]
  • Causative classification of stroke system (CCS)[4]
  • Sparkle classification of ischemic stroke[3]
.
 
 
 
 
 
 
 
 
 
 
 
 
 
Ischemic stroke
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on duration of onset of symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on cause
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Transient Ischemic stroke
(symptoms lasts <24 hrs)
 
Acute Ischemic stroke
(symptoms lasts >24 hrs)
 
 
Chronic ischemic stroke
 
 
 
 
 
 
 
Thrombotic
 
 
Embolic[5]

1.Atrial fibrillation
2.Fat
3.Septic
4.Air

5.Cancer
 
 
 
Vasculitic

Giant cell arteritis

Takayasu arteritis
 
 
Systemic hypoperfusion

1.Myocardial infarction
2.Pulmonary embolism
3.Pericardial effusion

4.Bleeding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TOAST classification[1]

1.Large artery atherosclerosis
2.Cardioembolism
3.Small vessel occlusion
4.Stroke of determined etiology

5.Stroke of undetermined etiology
 
 
 
 
 
 
 
 
 
Arterial thrombosis 1.Carotid artery
2.Vertebral artery
3.Circle of Willis
4.Middle cerbral artery
 
 
 
Venous thrombosis Central venous thrombosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Large vessel involvement

1.Atherosclerosis
2.Vasculitis
3.Noninflammatory vasculopathy

4.Fibromuscular dysplasia
 
 
 
 
Small vessel involvement

1.Fibrinoid degeneration
2.Lipohyalinosis

3.Microatheroma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stroke
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ischemic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemorrhagic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Large vessel thromboembolism
 
Cardioembolic
 
Small vessel or Lacunar infarct
 
Intra-axial
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Extra-axial
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intracerebral (ICH)
 
 
Subarachnoid hemorrhage (SAH)
 
 
 
 
 
 
 
Subdural Hemorrhage
 
 
 
 
 
 
 
 
Epidural Hemorrhage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intraparenchymal hemorrhage
 
 
 
 
Intraventricular hemorrhage (IVH)
 
 
 
 
Cerebral microbleeds

References

  1. 1.0 1.1 1.2 Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL; et al. (1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment". Stroke. 24 (1): 35–41. PMID 7678184.
  2. Adams HP, Biller J (2015). "Classification of subtypes of ischemic stroke: history of the trial of org 10172 in acute stroke treatment classification". Stroke. 46 (5): e114–7. doi:10.1161/STROKEAHA.114.007773. PMID 25813192.
  3. 3.0 3.1 Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD (2014). "SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes". Neuroepidemiology. 42 (4): 243–51. doi:10.1159/000362417. PMID 24862944.
  4. 4.0 4.1 Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M; et al. (2010). "The Causative Classification of Stroke system: an international reliability and optimization study". Neurology. 75 (14): 1277–84. doi:10.1212/WNL.0b013e3181f612ce. PMC 3013495. PMID 20921513.
  5. 5.0 5.1 Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR (2016). "Ischemic stroke classification and risk of embolism in patients with Chagas disease". J Neurol. doi:10.1007/s00415-016-8275-0. PMID 27624118 : 27624118 Check |pmid= value (help).
  6. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ (2005). "An evidence-based causative classification system for acute ischemic stroke". Ann Neurol. 58 (5): 688–97. doi:10.1002/ana.20617. PMID 16240340.
  7. McArdle PF, Kittner SJ, Ay H, Brown RD, Meschia JF, Rundek T; et al. (2014). "Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study". Neurology. 83 (18): 1653–60. doi:10.1212/WNL.0000000000000942. PMC 4223086. PMID 25261504.

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