Classification of Cardiogenic Stroke – Overcoming the Challenges

Precise analysis of stroke subtypes is important for clinical treatment decisions and prognostic evaluation of patients leading to adapted individual patient management. Cardiogenic stroke represents a major part with approximately one-third of all ischaemic strokes, but evaluation is not as simple as could be expected. This is reflected by new classification systems like the Atherosclerosis, Small Vessel Disease, Cardiac Origin and Other Causes (ASCO) score, which permits a more comprehensive evaluation of people who have had a stroke. They allow better presentation of concomitant stroke aetiologies that influence primary management and secondary prophylaxis in cardiogenic stroke patients. Careful analysis of different ischaemic stroke patterns as well as demonstration of either symptomatic or asymptomatic previous ischaemic stroke and/or intracerebral bleedings on magnetic resonance imaging (MRI) is essential for adequate interpretation and best individual choice of antiplatelet/anticoagulation treatment. As a consequence, all people who have had a stroke should undergo a complete stroke work-up, even if a cardioembolic source like atrial fibrillation might be easily detected initially. Future aspects will address the increasing numbers of old people with both neurodegenerative, vascular and cardiac diseases with mutual interference of treatment and prevention regimens.