Chinese ischemic stroke subclassification

S Gao, Y J Wang, A D Xu, Y S Li, D Z Wang, S Gao, Y J Wang, A D Xu, Y S Li, D Z Wang

Abstract

Accurate classification of stroke has significant impact on patient care and conduction of stroke clinical trials. The current systems such as TOAST, SSS-TOAST, Korean TOAST, and A-S-C-O have limitations. With the advent of new imaging technology, there is a need to have a more accurate stroke subclassification system. Chinese ischemic stroke subclassification (CISS) system is a new two step system aims at the etiology and then underlying mechanism of a stroke. The first step classify stroke into five categories: large artery atherosclerosis (LAA), including atherosclerosis of aortic arch and intra-/extracranial large arteries, cardiogenic stroke, penetrating artery disease, other etiology, and undetermined etiology. The second step is to further classify the underlying mechanism of ischemic stroke from the intracranial and extracranial LAA into the parent artery (plaque or thrombosis) occluding penetrating artery, artery-to-artery embolism, hypoperfusion/impaired emboli clearance, and multiple mechanisms. Although clinical validation of CISS is being planned, CISS is an innovative system that offers much more detailed information on the pathophysiology of a stroke.

Keywords: Chinese; etiology; ischemic stroke; mechanism; subclassification.

Figures

Figure 1
Figure 1
Illustration of large artery atherosclerosis, cardiogenic stroke, and penetrating artery disease.
Figure 2
Figure 2
Detailed illustration for intracranial large artery atherosclerosis and penetrating artery disease.
Figure 3
Figure 3
Overview of CISS.

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