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Most epidemiological studies have failed to find a link between blood-cholesterol levels and stroke, but studies that looked at some subtyping (ischemic vs. Other large epidemiological studies have found a strong association between carotid stenosis and blood cholesterol levels.
Although carotid stenosis is a cause of stroke, serum cholesterol levels have not been associated with atherothrombotic stroke because no epidemiologic studies have properly looked for this association in this particular subtype of ischemic stroke.
Strength of this classification:– Only patients with atherothrombosis likely to be causally related to stroke could be included in the group classified as having atherothrombotic stroke, with a large group of other individuals classified as having ‘stroke of unknown cause’.
The classification from the Oxfordshire Community Stroke Project (OCSP) was proposed to characterize this population-based epidemiological study [3, 4].
The investigators had to cope with the quality and cost of the work-up available at that time in the UK.
Modern MRI with diffusion-weighted imaging was not used at the time.– The evident overestimation of the group of ‘undetermined’ etiology (39% of the cohort), not only because the newer diagnostic tools were not available at that time (e.g.
transesophageal echocardiography, TEE, magnetic resonance angiography, MRA, duplex ultrasound examination, and transcranial Doppler), but also because of the restrictive definition of atherothrombotic causes and the inclusion in this group of patients with tandem lesions.
Computed tomography (CT) scanning was the best investigational test performed, but assessment of extra- and intracranial arteries and precise cardiac work-up were not available.
This likely led the OCSP investigators to classify patients according to the extent and site of brain infarction on clinical grounds alone (table 2).
The classification should distinguish between ischemic and hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis, and spinal cord stroke.
Regarding the 4 main categories of etiologies of ischemic stroke (i.e.
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