_id

683a1629c782e11e38d1b232

id

10036

title

ASCOD Algorithm for Ischemic Stroke

full_title

ASCOD Algorithm for Ischemic Stroke

short_title

ASCOD Algorithm for Ischemic Stroke

med_description

Assigns phenotype in patients with ischemic stroke of uncertain causes.

short_description

Ischemic stroke phenotype.

slug

ascod-algorithm-ischemic-stroke

description

The ASCOD Algorithm for Cryptogenic Stroke assigns phenotype in patients with ischemic stroke of uncertain causes.

keywords

ASCOD, cryptogenic stroke, ischemic stroke, stroke classification

complaint

[ "Headache", "Neurologic Deficit", "Seizure" ]

formula

Grades of predefined ASCOD phenotypes: Specific definitions:

evidence

• Ischemic stroke without clear etiology has historically been difficult to define and classify. In 2009, a new system for phenotyping patients called ASCO (A for atherosclerosis; S for small-vessel disease, C for cardiac pathology, and O for other causes) was proposed by expert consensus in order to better describe the overlap between multiple potential causative diseases underlying ischemic stroke (Amarenco 2009).

• ASCO was subsequently updated to include dissection (D), a common cause of stroke in young patients (Amarenco 2013).

• About 90% of ischemic stroke patients identified with ASCOD have atherosclerotic disease, highlighting importance of risk factor control regardless of most causal mechanism for index stroke. These patients have high overlap between multiple possible ischemic stroke etiologies (Sirimarco 2013).

• Reported interrater agreement for ASCOD classification is substantial: kappa 0.95 for large vessel atherosclerosis, 0.95 for small vessel disease, and 1 for cardiac disease, which outscores TOAST (Radu 2017).

• Some comparisons among proposed classification systems including TOAST, Causative Classification of Stroke (CCS) system, and ASCO show good overall agreement between all classification systems (Radu 2017).

• A recent study comparing TOAST, CCS, and ASCO finds that all systems generated etiologic subtypes with different 90-day stroke recurrence, 90-day survival, admission stroke severity, and acute infarct burden, with CCS providing the greatest discrimination in all outcomes except 90-day survival. This suggests CCS may be more suitable in etiologic subtype assessment in large stroke clinical trials (Arsava 2017).

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23899749 ", "text": "Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Wolf ME, Hennerici MG. The ASCOD phenotyping of ischemic stroke (Updated ASCO Phenotyping). Cerebrovasc Dis. 2013;36(1):1-5." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/7678184", "text": "Adams HP, Bendixen BH, Kappelle LJ, et al. 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. 1993;24(1):35-41." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/19342826", "text": "Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis. 2009;27(5):502-8." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013495/", "text": "Arsava EM, Ballabio E, Benner T, et al. The Causative Classification of Stroke system: an international reliability and optimization study. Neurology. 2010;75(14):1277-84." } ], "Outcomes": [], "Validation": [ { "href": "https://stroke.ahajournals.org/content/44/9/2427 ", "text": "Sirimarco G, Lavallée PC, Labreuche J, et al. Overlap of diseases underlying ischemic stroke: the ASCOD phenotyping. Stroke. 2013;44(9):2427-33." }, { "href": "https://www.sciencedirect.com/science/article/pii/S030384671730149X ", "text": "Radu RA, Terecoasă EO, Băjenaru OA, Tiu C. Etiologic classification of ischemic stroke: Where do we stand?. Clin Neurol Neurosurg. 2017;159:93-106." } ], "Validations": [] }

pearls

• 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.

usecase

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

reasons

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).

next_advice

• Incomplete minimum work-up may prompt further diagnostic testing listed in scoring criteria.

• Potential causal disease mechanisms should be treated according to current evidence-based guidelines for secondary stroke prevention.

• Multiple potentially causal disease mechanisms should all be considered for treatment.

next_actions

ASCOD addresses underlying ischemic stroke mechanisms, not all aspects of post-stroke care, which can include rehabilitation, physical therapy, occupational therapy, and speech language therapy.

next_management

Management is dependent on identified mechanism(s), and may include anticoagulation, anti-thrombotics, high-intensity anti-lipids, blood pressure and glycemic control, carotid endarterectomy, and/or atrial septal defect repair.

diseases

[ "Acute Coronary Syndrome", "Atrial Fibrillation", "Stroke / Transient Ischemic Attack (TIA)" ]

input_schema

[ { "inct": null, "option_fhir_rules": null, "subheading": "A: Causality grades for atherothrombosis ", "subheading_instructions": "", "type": "subheading" }, { "conditionality": "", "default": 1, "label_en": "<p>A9: Incomplete workup</p>", "mdcalc_info_concept": null, "name": "a9", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Ultrasound (Duplex or TCD), angiogram (CTA, MRA, or conventional), or autopsy not performed (a minimum workup is extra- and intracranial assessment of cerebral arteries - maximum workup also includes transesophageal assessment of the aortic arch (or a default CTA of the aortic arch))", "type": "radio" }, { "conditionality": "a9 == 0", "default": 0, "label_en": "<p>A1: Potentially causal (atherothrombotic stroke)</p>", "mdcalc_info_concept": null, "name": "a1", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "50-99% ipsilateral atherosclerotic stenosis in intra/extracranial artery supplying the ischemic field, ipsilateral atherosclerotic stenosis <50% in intra/extracranial artery with endoluminal thrombus supplying ischemic field, mobile thrombus in aortic arch, ipsilateral arterial occlusion in intra/extracranial artery with evidence of underlying atherosclerotic plaque supplying ischemic field", "type": "radio" }, { "conditionality": "a9 == 0", "default": 0, "label_en": "<p>A2: Causal link uncertain</p>", "mdcalc_info_concept": null, "name": "a2", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "30-50% ipsilateral atherosclerotic stenosis in intra/extracranial artery supplying the ischemic field, aortic plaque ≥4 mm without mobile lesion", "type": "radio" }, { "conditionality": "a9 == 0", "default": 0, "label_en": "<p>A3: Causal link unlikely but disease is present</p>", "mdcalc_info_concept": null, "name": "a3", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "<30% stenosis in intra/extracranial artery ipsilateral to infarct area, aortic plaque <4 mm without mobile thrombus, stenosis (any degree) or occlusion in a cerebral artery not supplying infarct area (e.g. contralateral side, opposite circulation), history of MI, coronary revascularization, or peripheral arterial disease, 50-99% ipsi/bilateral atherosclerotic stenosis with bihemispheric magnetic resonance-diffusion-weighted imaging (DWI) lesion", "type": "radio" }, { "conditionality": "a9 == 0", "default": 0, "label_en": "<p>A0: Atherosclerosis not detected and ruled out</p>", "mdcalc_info_concept": null, "name": "a0", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Any of the following done and negative for extracranial arterial stenosis: duplex US, CTA, MRA, conventional angiogram, or autopsy; any of the following done and negative for intracranial arterial stenosis: transcranial Doppler US, MRA, CTA, conventional angiogram, or autopsy; transesophageal echocardiography with specific assessment of the aortic arch (when the probe is pulled back at end of cardiac examination, turn probe counterclockwise and watch aortic arch), or specific aortic arch assessment with CTA to rule out aortic arch atheroma", "type": "radio" }, { "inct": null, "option_fhir_rules": null, "subheading": "S: Causality grades for small-vessel disease", "subheading_instructions": "", "type": "subheading" }, { "conditionality": "", "default": 1, "label_en": "<p>S9: Incomplete workup</p>", "mdcalc_info_concept": null, "name": "s9", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "MRI or CT not done", "type": "radio" }, { "conditionality": "s9 == 0", "default": 0, "label_en": "<p>S1: Potentially causal</p>", "mdcalc_info_concept": null, "name": "s1", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Lacunar infarction, defined as small deep infarct <15 mm in perforator branch territory on MRI-DWI or default CT in area corresponding to symptoms, plus ≥1 of the following: ≥1 small deep older infarct(s) of lacunar type in other territories; severe (confluent/Fazekas III) leukoaraiosis, or microbleeds, or severe dilatation of perivascular spaces (‘état criblé’); repeated, recent (<1 month), TIAs attributable to the same territory as the index infarct", "type": "radio" }, { "conditionality": "s9 == 0", "default": 0, "label_en": "S2: Causal link uncertain", "mdcalc_info_concept": null, "name": "s2", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Only one recent lacunar infarction and no other abnormality on MRI/CT, clinical syndrome suggestive of deep branch artery stroke, without ischemic lesion in appropriate area on MRI/CT (main clinical syndrome suggesting a deep branch artery/lacunar stroke: pure hemiparesis, pure hemisensory loss, ataxic hemiparesis, dysarthria-clumsy hand syndrome, unilateral sensorimotor deficit, others: hemichorea, hemiballism, pure dysarthria, etc) ", "type": "radio" }, { "conditionality": "s9 == 0", "default": 0, "label_en": "S3: Causal link unlikely, but disease is present", "mdcalc_info_concept": null, "name": "s3", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Severe (confluent/Fazekas III) leukoaraiosis visible on MRI and/or CT scan, and/or microbleeds visible on T2-weighted MRI, and/or severe dilatation of perivascular spaces (visible on T2-weighted MRI), and/or one or several old, small deep infarcts of lacunar type ", "type": "radio" }, { "conditionality": "s9 == 0", "default": 0, "label_en": "S0: Small-vessel disease not detected", "mdcalc_info_concept": null, "name": "s0", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Negative MRI (T2, FLAIR, GRE, DWI) and no clinical syndrome suggestive of deep branch artery stroke ", "type": "radio" }, { "inct": null, "option_fhir_rules": null, "subheading": "C: Causality grades for cardiac pathology", "subheading_instructions": "", "type": "subheading" }, { "conditionality": "", "default": 1, "label_en": "<p>C9: Incomplete workup</p>", "mdcalc_info_concept": null, "name": "c9", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Minimum is EKG and examination by trained cardiologist in absence of cardiac imaging", "type": "radio" }, { "conditionality": "c9 == 0", "default": 0, "label_en": "<p>C1: Potentially causal</p>", "mdcalc_info_concept": null, "name": "c1", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Acute cardiogenic stroke, or recent stroke and older bihemispheric, supra/infratentorial territorial, or cortical ischemic lesions and signs of systemic embolism with ≥1 of the following: mitral stenosis (surface area <1.5 cm²), mechanical valve, MI within 4 weeks before stroke mural thrombus in the left cavities, left ventricular aneurysm, history or presence of documented afib (paroxysmal (>60 seconds), persistent, or permanent) or flutter, with or without left atrial thrombus or spontaneous echo, atrial disease (tachy-brady syndrome), dilated or hypertrophic cardiomyopathies, left ventricle ejection fraction <35%, endocarditis, intracardiac mass, patent foramen ovale (PFO) and thrombus in situ, PFO and concomitant PE or proximal DVT preceding the index stroke, aforementioned cardiac pathologies (C1) with single or without obvious cerebral ischemic lesion ", "type": "radio" }, { "conditionality": "c9 == 0", "default": 0, "label_en": "<p>C2: Causal link is uncertain (one of the following, regardless of stroke pattern)</p>", "mdcalc_info_concept": null, "name": "c2", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "PFO and atrial septal aneurysm, PFO and PE or proximal DTV concomitant but NOT preceding the index stroke, intracardiac spontaneous echo-contrast, apical akinesia of the left ventricle and decreased ejection fraction (but >35%), history of MI or palpitation and multiple brain infarction, repeated either bilateral or in two different arterial territories (e.g. both anterior and posterior circulation), no direct cardiac source identified, but multiple brain infarction, repeated either bilateral or in two different arterial territories (e.g. both anterior and posterior circulation) and/or evidence of systemic emboli: renal or splenic or mesenteric infarction (on CT, MRI, or autopsy) or embolism in peripheral artery supplying arm or leg", "type": "radio" }, { "conditionality": "c9 == 0", "default": 0, "label_en": "<p>C3: Causal link unlikely but disease is present (one of the following abnormalities present in isolation)</p>", "mdcalc_info_concept": null, "name": "c3", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "PFO, atrial septal aneurysm (ASA), strands, mitral annulus calcification, aortic valve calcification, nonapical akinesia of left ventricle, transient afib <60 sec, or atrial hyperexcitability ", "type": "radio" }, { "conditionality": "c9 == 0", "default": 0, "label_en": "<p>C0: Cardiac pathology not detected or not suspected</p>", "mdcalc_info_concept": null, "name": "c0", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Ruling out a cardiac source of embolism: minimum is negative EKG and examination by a cardiologist; maximum is negative EKG/telemetry/24-hour Holter EKG/long-term EKG recording (implantable device, transtelephonic EKG, loop recorder), negative TEE for atrium, valves, and septal abnormalities, negative transthoracic echocardiogram (TTE) for PFO and assessment of left ventricle, negative cardiac CT/MRI, and negative abdominal CT/MRI (search for old or simultaneous subdiaphragmatic visceral infarction)", "type": "radio" }, { "inct": null, "option_fhir_rules": null, "subheading": "O: Causality for other causes", "subheading_instructions": "", "type": "subheading" }, { "conditionality": "", "default": 1, "label_en": "<p>O9: Incomplete workup</p>", "mdcalc_info_concept": null, "name": "o9", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Unable to reasonably exclude other causes based on best available diagnostic tests and stroke-specific history ", "type": "radio" }, { "conditionality": "o9 == 0", "default": 0, "label_en": "<p>O1: Potentially causal</p>", "mdcalc_info_concept": null, "name": "o1", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Dolichoectasia with complicated aneurysm, polycythemia vera or thrombocythemia >800,000/mm³, systemic lupus, disseminated intravascular coagulation, antiphospholipid antibody syndrome (including >100 IgG antiphospholipid (GPL) units or lupus anticoagulant), Fabry’s disease, coexisting meningitis, sickle cell disease, ruptured intracranial aneurysm with or without vasospasm of the artery supplying the infarcted area, severe hyperhomocysteinemia, Horton’s disease, other cerebral inflammatory or infectious angiitis, Moyamoya disease, etc.", "type": "radio" }, { "conditionality": "o9 == 0", "default": 0, "label_en": "<p>O2: Causal link is uncertain</p>", "mdcalc_info_concept": null, "name": "o2", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Saccular aneurysm (with suspicion of embolism), coincidental migraine attack with neurological deficit lasting >60 min in patients with history of migraine aura ", "type": "radio" }, { "conditionality": "o9 == 0", "default": 0, "label_en": "O3: Causal link is unlikely but disease is present", "mdcalc_info_concept": null, "name": "o3", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Arteriovenous malformation, thrombocytosis <800,000/mm³ antiphospholipid antibody <100 GPL units, homocysteinemia <40 μmol/L, malignoma with associated hypercoagulation (high D-dimer levels), DVT/PE and/or recent chemotherapy", "type": "radio" }, { "conditionality": "o9 == 0", "default": 0, "label_en": "<p>O0: Cardiac pathology not detected or not suspected</p>", "mdcalc_info_concept": null, "name": "o0", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Ruling out other causes: negative Cerebrospinal fluid (CSF), complete hemostasis, cerebral arterial imaging, family history of inherited disease, inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)), hematologic tests (platelet, leukocytes, and eosinophilic counts; hematocrit), specific tests according to suspected disease (e.g. genetic test, retinal angiography for Susac syndrome)", "type": "radio" }, { "inct": null, "option_fhir_rules": null, "subheading": "D: Causality grades for dissection", "subheading_instructions": "", "type": "subheading" }, { "conditionality": "", "default": 1, "label_en": "<p>D9: Incomplete workup</p>", "mdcalc_info_concept": null, "name": "d9", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "In patients <60 years old and no evidence of A1, A2, S1, C1, or O1 category: no fat-saturated MRI performed on the extra/intracranial artery supplying the ischemic field or no x-ray angiography performed (all performed within 15 days of symptom onset)", "type": "radio" }, { "conditionality": "d9 == 0", "default": 0, "label_en": "D1: Potentially causal ", "mdcalc_info_concept": null, "name": "d1", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Arterial dissection by direct demonstration (evidence of mural hematoma: hypersignal on fat-saturated MRI or at autopsy or on TOF-MRA or CT on axial sections showing both enlargement of the arterial wall by the hematoma with narrowing of the lumen or on echography showing an hypoechoic arterial wall with narrowing of the lumen and sudden enlargement of the carotid or vertebral (V2) artery diameter, arterial dissection by indirect demonstration or by less sensitive/less specific diagnostic test (only long arterial stenosis beyond carotid bifurcation or in V2, V3, or V4 without demonstration of arterial wall hematoma: on x-ray angiography, and/or echography and/or CTA and/or MRA) or unequivocal US with recanalization during follow-up", "type": "radio" }, { "conditionality": "d9 == 0", "default": 0, "label_en": "D2: Causal link uncertain", "mdcalc_info_concept": null, "name": "d2", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Arterial dissection by weak evidence (suggestive clinical history, e.g. painful Horner’s syndrome or past history of arterial dissection), imaging evidence of fibromuscular dysplasia of a cerebral artery supplying ischemic field ", "type": "radio" }, { "conditionality": "d9 == 0", "default": 0, "label_en": "D3: Causal link unlikely but disease is present", "mdcalc_info_concept": null, "name": "d3", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Kinking or dolichoectasia without complicated aneurysm or plicature, fibromuscular dysplasia on arteries not supplying ischemic field ", "type": "radio" }, { "conditionality": "d9 == 0", "default": 0, "label_en": "D0: No dissection detected or suspected", "mdcalc_info_concept": null, "name": "d0", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Ruling out dissection: negative fat-saturated MRI of suspected artery or good quality, normal x-ray angiography (too early fat-saturated MRI performed within three days of symptom onset can be falsely negative and then should be repeated). If no clinical suspicion of dissection, patient can be classified D0 provided good-quality extra/intracranial cerebral artery and cardiac evaluations have been done", "type": "radio" } ]

instructions

published

2022-04-21T20:28:08.223Z

purpose

[ "Algorithm", "Diagnosis" ]

search_terms

[ "ESUS", "ASCOD", "TIA", "stroke", "ischemic stroke", "cryptogenic stroke", "stroke risk" ]

seo

{ "keywords_en": "ASCOD, cryptogenic stroke, ischemic stroke, stroke classification ", "meta_description_en": "The ASCOD Algorithm for Cryptogenic Stroke assigns phenotype in patients with ischemic stroke of uncertain causes. " }

specialty

[ "Cardiology", "Critical Care (Neurologic)", "Emergency Medicine", "Family Practice", "Internal Medicine", "Neurology", "Neurosurgery", "Primary Care", "Radiology" ]

departments

[ "Neurologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 40, "short_title_en": "CHADS₂ Score", "slug": "chads2-score-atrial-fibrillation-stroke-risk" }, { "calcId": 10504, "short_title_en": "GARFIELD-AF", "slug": "garfield-af" }, { "calcId": 10007, "short_title_en": "ESUS Criteria", "slug": "embolic-stroke-undetermined-source-esus-criteria" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "neurology" ]

cleaned_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." ]

pub

false