Stroke is the most common cause of morbidity and the fifth leading cause of mortality in the United States. There are different underlying mechanisms that can cause a stroke. It is essential to determine the underlying etiology of the stroke to guide evidence-based therapy for secondary prevention such as anticoagulation for atrial fibrillation, and revascularization in cervical carotid artery stenosis.
In 1993 The Trial of Org 10172 in Acute Stroke Treatment (TOAST) was published and it classified stroke into large artery atherosclerosis, cardioembolic, small vessel, other determined etiology such as arterial dissection and undetermined etiology.
The ASCOD classification on the other hand classifies stroke etiology into atherosclerosis, small vessel disease, cardiac pathology, arterial Dissection, and other causes.
Embolic strokes can have a cardiac source, artery to artery, paradoxical embolism from a venous source in patients with patent foramen ovale (PFO), aortic source, or embolic stroke due to undetermined source ESUS.
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