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Personalising secondary prevention: different treatments for different strokes
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  • Published on:
    Personalising secondary prevention for stroke: the importance of considering multiple aetiologies
    • Sergio A. Castillo-Torres, Clinical Neurology Resident Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, NL, México.
    • Other Contributors:
      • Fernanda Flores-Alfaro, Clinical Neurology Resident
      • Fernando Góngora-Rivera, Vascular Neurologist, Professor of Neurology

    With great interest, we read the review by Markus on personalising the secondary prevention approach to patients with stroke ¹, published in the most recent issue of Practical Neurology. Where we are presented with clinically useful and evidence-based advice for the etiological assessment of patients with acute ischemic stroke (AIS), focusing on lacunar stroke syndromes of a non-lacunar cause, and its appropriate therapeutic management. We consider the article of great importance: a must-read for all physicians who care for patients with AIS since etiological assessment is paramount to dictate the appropriate secondary prevention measures.

    The author proposes using the TOAST classification (Trial of Organon 10172 in Acute Stroke Treatment), arguing that classification systems that prime clinical syndromes over pathophysiological mechanisms are less useful. Nevertheless, the author omitted one classification which–partially–resolves the issue: the ASCOD (Atherosclerosis, Small-vessel, Cardiac embolism, Other, Dissection) system ². A comprehensive classification, which allows for more than one aetiology, while giving a degree of a causal relationship to the presence of each category of disease (1 potential, 2 uncertain, 3 unlikely, 0 disease not detected) including incomplete assessment (9 insufficient work-up), while considering some clinical features.

    The ASCOD approach permits the identification of patients with diseases that would have been left as indeterm...

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    Conflict of Interest:
    None declared.