SPARKLE (Subtypes of Ischaemic Stroke Classification System), Incorporating Measurement of Carotid Plaque Burden: A New Validated Tool for the Classification of Ischemic Stroke Subtypes

Abstract

Background: Previous classification systems of acute ischemic stroke (Causative Classification System, CCS, of acute ischemic stroke, Trial of Org 10172 in Acute Stroke Treatment, TOAST) established the diagnosis of large artery disease (LAD) based on the presence or absence of carotid stenosis. However, carotid plaque burden is a stronger predictor of cardiovascular risk than stenosis. Our objective was to update definitions of ischemic stroke subtypes to improve the detection of LAD and to assess the validity and reliability of a new classification system: SPARKLE (Subtypes of Ischaemic Stroke Classification System). Methods: In a retrospective review of clinical research data, we compared three stroke subtype classifications: CCS, TOAST and SPARKLE. We analyzed a random sample of 275 patients presenting with minor stroke or transient ischemic attack (TIA) in an Urgent TIA Clinic in London, Ont., Canada, between 2002 and 2012. Results: There was substantial overall agreement between SPARKLE and CCS (κ = 0.75), with significant differences in the rate of detection of LAD, cardioembolic and undetermined causes of stroke or TIA. The inter-rater reliability of SPARKLE was substantial (κ = 0.76) and the intra-rater reliability was excellent (κ = 0.91). Conclusion: SPARKLE is a valid and reliable classification system, providing advantages compared to CCS and TOAST. The incorporation of plaque burden into the classification of LAD increases the proportion of cases attributable to LAD and reduces the proportion classified as being of 'undetermined' etiology.

Secular Trends in Ischemic Stroke Subtypes and Stroke Risk Factors

“…Therefore, we think that if any information bias exists, it will be nondifferential over time. However, it should be noted that, as described in our article on the stroke subtype classification system used in this study, 4 measurement of carotid plaque burden aids in the diagnosis of cardioembolic stroke because patients with little or no carotid plaque are considered less likely to have large artery disease.…”

“…The final adjudication of ischemic stroke subtypes was based on the review of the history, neurological examination, and all test results. 4 …”

Aplicación de los sistemas TOAST y CCS en el diagnóstico de accidente cerebrovascular isquémico

“…13 Otro sistema de clasificación basado en arteriosclerosis de vasos pequeños, enfermedad cardiaca y otras causas (ASCO) podría contribuir a una mejor clasificación de los pacientes con ACVi. 14 Este trabajo presenta ciertas limitaciones, por ejemplo, el análisis retrospectivo no nos permitió incorporar a todos los pacientes llegados al servicio en el periodo estudiado, ya que no todos poseían los datos clínicos y bioquímicos completos para aplicar el algoritmo estandarizado. Si bien la mayoría de los pacientes poseía la información del ecocardiograma transesofágico y electrocardiograma, así como los parámetros plasmáticos de coagulación, otros estudios específicos se realizaron sólo cuando se indicaron clínicamente.…”

Risk of Stroke at the Time of Carotid Occlusion

“…The TIA and stroke events were classified as ipsilateral or contralateral to the side of the index occlusion and by their stroke subtype (large artery atherosclerosis, cardioembolic, small vessel disease, other rare or unusual causes, and undetermined), using the SPARKLE (Subtypes of Ischaemic Stroke Classification System) classification. 9 The primary outcome was a combination of ipsilateral stroke, ipsilateral TIA, or death from ipsilateral stroke or unknown cause. The decision to include TIA in the primary outcome was based on the concept that the occurrence of TIAs would likely lead to intervention.…”