Classifying Ischemic Stroke, from TOAST to CISS

Abstract

SUMMARYIschemic stroke classification is critical in conducting basic research and clinical practice. A precise analysis of stroke subtypes requires the integration of clinical features, findings from diagnostic tests, and knowledge about potential etiologic factors by competent diagnostic investigators. We performed a literature review of the published stroke classification systems and examined each for its benefits and limitations in the evaluation of the stroke etiology. Two major approaches to etiologic classifications of ischemic stroke are currently being used: the causative and phenotypic subtyping. The most widely used causative system is the Trial of Org 10172 in acute stroke treatment (TOAST) classification. With the advances in modern diagnostic technology, new stroke subclassification systems, such as the causative classification system (CCS) and Chinese ischemic stroke subclassification (CISS) system, have been developed to enhance the accuracy of TOAST. The A-S-C-O (Atherosclerosis, Smallvessel disease, Cardiac source, Other cause) phenotypic classification system makes efforts to identify the most likely etiology but not neglecting the possibility of other potential multiple causes. We conclude that the ideal stroke classification system needs to be valid, easy to use, evidence-based, and incorporate new information as it emerges.

Epidemiology Investigation of stroke among Mongolian and Han population aged over 45 in Inner Mongolia

“…The median age of onset in the eastern region was 61 years, 59 years in the central region and 57 years in the western region14, which might be related to economics and medical conditions. Three large-scale surveys on stroke in China were conducted in 1985, 1986, and 199191516. Because the survey year and age–sex structure of the investigation area varied in these previous studies, their results might differ from those in our study.…”

“…The head of the project made the final diagnosis combined with the examination results. Ischemic stroke was diagnosed by the criteria used in Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification9.…”

Serum amyloid A, fetuin-A, and pentraxin-3 levels in patients with ischemic stroke: novel prognostic biomarkers?

“…Standard laboratory tests, 12-lead electrocardiography, and cranial computerized tomography (CT) were performed on admission. The type of AIS was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) (14): cardioembolic infarct (CEI), large-artery atherosclerosis (LAAS), lacunar infarct (LAC), stroke of undetermined etiology (UDE), and stroke of other determined etiology (ODE). Infarct volumes were measured by CT.…”

Disability caused by post-stroke visual impairment as an underestimated clinical problem — case report

“…It is defined as a sudden development of neurological deficits due to impaired blood flow to the central nervous system. The major aetiological factors of ischaemic cerebral stroke based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) are presented in Table 1 [5,6].…”