ASCO Stroke Classification

A - Atherosclerosis ▼

Grade 1 (Definite)

• Arterial stenosis ≥50% in clinically relevant artery
• Mobile thrombus in aorta/relevant arteries
• Multiple TIAs in same territory

Grade 2 (Probable)

• Arterial stenosis 30-50% in relevant artery
• Unstable arterial plaque
• Aortic arch plaques ≥4mm

Grade 3 (Possible)

• Arterial stenosis <30%
• Aortic arch plaques <4mm
• Vascular risk factors present

S - Small Vessel Disease ▼

Grade 1 (Definite)

• Classic lacunar syndrome with relevant infarct <15mm
• Multiple lacunar infarcts with hypertension/diabetes
• Microbleeds on gradient-echo MRI

Grade 2 (Probable)

• Single lacunar syndrome without MRI confirmation
• White matter lesions with risk factors
• Multiple lacunar infarcts without risk factors

Grade 3 (Possible)

• Non-specific white matter changes
• Single lacunar infarct without risk factors
• Borderzone infarcts

C - Cardiac Source ▼

Grade 1 (Definite)

• Atrial fibrillation/flutter
• Recent myocardial infarction
• Left ventricular thrombus
• Infective endocarditis

Grade 2 (Probable)

• Patent foramen ovale with DVT/PE
• Atrial septal aneurysm
• Left ventricular aneurysm without thrombus

Grade 3 (Possible)

• Patent foramen ovale without DVT
• Minor cardiac valve abnormalities
• Mild left ventricular dysfunction

O - Other Causes ▼

Grade 1 (Definite)

• Confirmed arterial dissection
• Genetic disorders (CADASIL, Fabry)
• Proven vasculitis

Grade 2 (Probable)

• Suspected arterial dissection
• Suspected vasculitis
• Incomplete hypercoagulable testing

Grade 3 (Possible)

• Suggestive history without confirmation
• Family history of genetic disorders
• Non-specific inflammatory markers

ASCO Score Calculator

A - 0 (Absent) A - 1 (Definite) A - 2 (Probable) A - 3 (Possible) A - 9 (Insufficient) S - 0 (Absent) S - 1 (Definite) S - 2 (Probable) S - 3 (Possible) S - 9 (Insufficient) C - 0 (Absent) C - 1 (Definite) C - 2 (Probable) C - 3 (Possible) C - 9 (Insufficient) O - 0 (Absent) O - 1 (Definite) O - 2 (Probable) O - 3 (Possible) O - 9 (Insufficient)

ASCO Score: A0-S0-C0-O0