What are the subtypes of ischemic stroke?

Jeffrey Saver, MD

There are three major subtypes of ischemic (blockage) stroke. “Large artery atherosclerotic stroke” is due to cholesterol (fatty plaque buildup) in large blood vessels going to the brain. “Small vessel stroke”is due to plaque buildup or thickening of small perforating blood vessels within the brain. “Cardioembolic stroke” is due to clots arising on the valves or wall of the heart, breaking off and traveling to the brain.

Most strokes are ischemic: that is, they are caused by a blockage in a blood vessel in or leading to the brain. Not all are alike; each subtype develops for different reasons, and poses particular challenges for diagnosis and treatment.

The subtypes of ischemic stroke are:

  • Embolic (a blood clot from the heart, aorta, or other source travels toward the brain, blocking a blood vessel that supplies blood to the brain) -- about 25% of ischemic strokes.
  • Large-artery atherothrombotic stroke (atherosclerotic plaque builds up and narrows an artery in any of four strategic locations) -- about 15% of ischemic strokes.
  • Small-vessel (lacunar) stroke (caused by obstruction of a single blood vessel that branches off the circle of arteries in the brain known as the circle of Willis) -- about 25% of ischemic strokes.
  • Cryptogenic stroke (an ischemic stroke is classified as cryptogenic if, after attempts to pinpoint the origin of a stroke, no source can be identified) -- about 25% to 30% of ischemic strokes.
  • Other subtypes of ischemic stroke (these include rarer causes such as arteritis (inflammation of small blood vessels), genetic factors affecting small vessels, or traumatic dissection (tearing) of a large artery outside the brain, usually in younger people) -- about 5% of ischemic strokes.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.