User requirements
This codelist aims to identify adult patients who have cerebrovascular disease where an atherosclerotic pathology exists.
We considered 'cerebrovascular disease' to refer to pathologies that primarily supplied or existed within cerebral or retinal circulation.
It will then be used as part of a stratification group (for broader atherosclerotic cardiovascular disease) when looking at patients prescribed GLP-1 agonists.
Relevant literature
Note that since the NICE TA refers to cerebrovascular disease within the overarching context of 'atherosclerotic cardiovascular disease', it is assumed that the guidance aims to identify only forms of atherosclerotic cerebrovascular disease.
Coding system
SNOMED CT
Existing relevant codelists
None identified.
Search terms / synonyms / search strategy
Search terms
- Cerebrovascular disease
- Stroke
- Cerebral infarction
- Cerebral ischaemia
- Transient ischaemic attack
- Carotid stenosis
- Atheroma
- Arteriosclerotic vascular disease
- Stenosis of artery
- Occlusion of artery
Inclusion criteria for codes
Codes which when applied in clinical records are expected to indicate that cerebrovascular disease caused by an atherosclerotic pathology exists in >75% cases.
Exclusion criteria for codes
Codes which when applied in clinical records are expected to indicate that cerebrovascular disease caused by an atherosclerotic pathology exists in <75% cases.
Borderline cases
INCLUDED
Codes which broadly refer to 'cerebrovascular disease' without explicit mention of atherosclerotic pathology. These could refer to non-atherosclerotic pathological causes such inflammatory, haemorrhagic, or embolic. However, where cerebrovascular disease is applied in GP records it is commonly used as shorthand for an atherosclerotic disease; non-atherosclerotic causes would usually attract a more specific code to clarify the diagnosis.
Codes which use the term 'thrombotic' or 'thrombosis' (unless describing venous system) - suggests in-situ clot formation, which would in the vast majority of cases reflect underlying atherosclerotic plaque.
Codes which use the term 'occlusive', 'occlusion', or 'obstruction' (unless other exclusion criteria apply below). I tend to see these phrasings as most commonly used to describe macrovascular atherosclerotic pathology, e.g. occlusion of 30%, although it is possible that some of these will be embolic events.
EXCLUDED
Codes which broadly refer to cerebrovascular events such as 'cerebral ischemia', or 'stroke' without explicit mention of atherosclerotic pathology. These events could be caused by either atherosclerotic or embolic pathologies, but are more commonly embolic. In addition, atherosclerotic causes are usually identifiable in imaging and would usually accompanied by a code which is more explicitly linked to atherosclerosis.
Arteriopathic granular atrophy of cerebral cortex 111028009 - more likely refer to small-vessel degenerative changes e.g. hypertensive or age-related, rather than large-artery atherosclerosis.
Bregeat's syndrome 254775002 - often congential in nature rather than driven by atherosclerotic pathology.
Some codes (depending on site) which explicitly refer to bilateral disease. Bilateral presentation increases probability of an embolic or systemic cause, for example:
Occlusion of bilateral central retinal arteries 347011000119102
Occlusion of bilateral cerebellar arteries 1153638002
Thrombosis of bilateral cerebellar arteries 1269244003
Cerebrovascular accident due to occlusion of bilateral middle cerebral arteries 188174841000119103
Cerebrovascular accident due to occlusion of bilateral carotid arteries 16644541000119106
Cerebrovascular accident of basal ganglia 595899961000119100 - basal ganglion stroke is typically classified as a lacunar infarct, i.e. affecting small vessels, and is usually due to diabetes, hypertension or aging rather than atherosclerotic disease.
Cerebrovascular accident of thalamus 769023031000119104 - strokes in the thalamus are quite commonly lacunar in nature.
Cerebral ischemic stroke due to aortic arch embolism 788881005 - aortic arch emboli typically arise from atherosclerotic plaques. However, the cerebrovascular disease mechanism in this context is embolic. So, excluded from this codelist and would expect to pick up atherosclerotic disease in this context under a separate codelist for ischaemic heart disease.
Final codelist
https://www.opencodelists.org/codelist/opensafely/cerebrovascular-disease/2a7b6235/
User requirements
This codelist aims to identify adult patients who have cerebrovascular disease where an atherosclerotic pathology exists.
We considered 'cerebrovascular disease' to refer to pathologies that primarily supplied or existed within cerebral or retinal circulation.
It will then be used as part of a stratification group (for broader atherosclerotic cardiovascular disease) when looking at patients prescribed GLP-1 agonists.
Relevant literature
Note that since the NICE TA refers to cerebrovascular disease within the overarching context of 'atherosclerotic cardiovascular disease', it is assumed that the guidance aims to identify only forms of atherosclerotic cerebrovascular disease.
Coding system
SNOMED CT
Existing relevant codelists
None identified.
Search terms / synonyms / search strategy
Search terms
Inclusion criteria for codes
Codes which when applied in clinical records are expected to indicate that cerebrovascular disease caused by an atherosclerotic pathology exists in >75% cases.
Exclusion criteria for codes
Codes which when applied in clinical records are expected to indicate that cerebrovascular disease caused by an atherosclerotic pathology exists in <75% cases.
Borderline cases
INCLUDED
Codes which broadly refer to 'cerebrovascular disease' without explicit mention of atherosclerotic pathology. These could refer to non-atherosclerotic pathological causes such inflammatory, haemorrhagic, or embolic. However, where cerebrovascular disease is applied in GP records it is commonly used as shorthand for an atherosclerotic disease; non-atherosclerotic causes would usually attract a more specific code to clarify the diagnosis.
Codes which use the term 'thrombotic' or 'thrombosis' (unless describing venous system) - suggests in-situ clot formation, which would in the vast majority of cases reflect underlying atherosclerotic plaque.
Codes which use the term 'occlusive', 'occlusion', or 'obstruction' (unless other exclusion criteria apply below). I tend to see these phrasings as most commonly used to describe macrovascular atherosclerotic pathology, e.g. occlusion of 30%, although it is possible that some of these will be embolic events.
EXCLUDED
Codes which broadly refer to cerebrovascular events such as 'cerebral ischemia', or 'stroke' without explicit mention of atherosclerotic pathology. These events could be caused by either atherosclerotic or embolic pathologies, but are more commonly embolic. In addition, atherosclerotic causes are usually identifiable in imaging and would usually accompanied by a code which is more explicitly linked to atherosclerosis.
Arteriopathic granular atrophy of cerebral cortex 111028009- more likely refer to small-vessel degenerative changes e.g. hypertensive or age-related, rather than large-artery atherosclerosis.Bregeat's syndrome 254775002- often congential in nature rather than driven by atherosclerotic pathology.Some codes (depending on site) which explicitly refer to bilateral disease. Bilateral presentation increases probability of an embolic or systemic cause, for example:
Occlusion of bilateral central retinal arteries 347011000119102Occlusion of bilateral cerebellar arteries 1153638002Thrombosis of bilateral cerebellar arteries 1269244003Cerebrovascular accident due to occlusion of bilateral middle cerebral arteries 188174841000119103Cerebrovascular accident due to occlusion of bilateral carotid arteries 16644541000119106Cerebrovascular accident of basal ganglia 595899961000119100- basal ganglion stroke is typically classified as a lacunar infarct, i.e. affecting small vessels, and is usually due to diabetes, hypertension or aging rather than atherosclerotic disease.Cerebrovascular accident of thalamus 769023031000119104- strokes in the thalamus are quite commonly lacunar in nature.Cerebral ischemic stroke due to aortic arch embolism 788881005- aortic arch emboli typically arise from atherosclerotic plaques. However, the cerebrovascular disease mechanism in this context is embolic. So, excluded from this codelist and would expect to pick up atherosclerotic disease in this context under a separate codelist for ischaemic heart disease.Final codelist
https://www.opencodelists.org/codelist/opensafely/cerebrovascular-disease/2a7b6235/