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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    ASCOD Algorithm for Ischemic Stroke

    Assigns phenotype in patients with ischemic stroke of uncertain causes.
    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients for comprehensive evaluation of all potential underlying causes of ischemic stroke, which may aid in those of unclear or overlapping etiology.

    • ASCOD phenotyping of ischemic stroke seeks to assign a degree of likelihood of causal relationship for every potential underlying disease mechanism, without weighing towards most likely cause. Compared to other ischemic stroke subtype classification systems:

      • Classifies subtypes into large-vessel atherosclerosis, small-vessel disease (lacunar), cardioembolic, and other etiologies including dissection, like TOAST (Trial of Org 10172 in Acute Stroke Treatment).

      • Does not assign a “cryptogenic” or “undetermined” category, which creators propose may reduce confusion amongst both clinicians and patients.

      • Captures overlap between multiple underlying ischemic stroke mechanisms.

      • Evaluates thoroughness and appropriateness of diagnostic evidence.

      • Relies on presence or absence of an abnormality, and does not directly compare competing ischemic stroke etiologies.

    • May aid in comprehensive evaluation of diagnostic work-up and findings to capture all existing underlying disease mechanisms in ischemic stroke patients, thus potentially guiding risk factor management for secondary prevention.

    • Compared with TOAST, reduces proportion of strokes labelled “of undetermined etiology” despite extensive work-up (Radu 2017).

    A: Causality grades for atherothrombosis
    No
    Yes
    S: Causality grades for small-vessel disease
    No
    Yes
    C: Causality grades for cardiac pathology
    No
    Yes
    O: Causality for other causes
    No
    Yes
    D: Causality grades for dissection
    No
    Yes

    Diagnostic Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Pierre Amarenco

    About the Creator

    Pierre Amarenco, MD, is a professor of neurology at Paris-Diderot Sorbonne University in Paris, France. He is also the chairman of the department of neurology and stroke center at the Bichat University Hospital in Paris, France. Dr. Amarenco's primary research is focused on prognosis and treatment of stroke.

    To view Dr. Pierre Amarenco's publications, visit PubMed

    Are you Dr. Pierre Amarenco? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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    About the Creator
    Dr. Pierre Amarenco
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