Design of the trial of Org 10172 in acute stroke treatment (TOAST)

Adams, Harold P.; Woolson, Robert F.; Clarke, William R.; Davis, Patricia H.; Bendixen, Birgitte H.; Love, Betsy B.; Wasek, Patricia A.; Grimsman, Karla J.

doi:10.1016/s0197-2456(97)00012-3

Cited by 61 publications

(41 citation statements)

References 36 publications

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“…Long-term outcome was assessed after 90 days using the NIHSS (NIHSS d90), modified Rankin scale (mRS) and Barthel Index (BI) during an outpatient visit or a structured telephone interview. Etiology of stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) [10]. …”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging and Clinical Patterns of Patients with ‘Spectacular Shrinking Deficit’ after Acute Middle Cerebral Artery Stroke

Kraemer

Thomalla²,

Soennichsen³

et al. 2005

Cerebrovasc Dis

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Background: Rapid resolution of neurological deficits after severe middle cerebral artery (MCA) stroke has been coined spectacular shrinking deficit (SSD). We studied clinical and MRI patterns in patients with SSD. Methods: Patients with acute MCA stroke <6 h were examined by stroke MRI (perfusion- and diffusion-weighted imaging (PWI, DWI), MR angiography (MRA)) at admission, day 1 and day 7. SSD was defined as a ≧8-point-reduction of neurological deficit in the National Institute of Health Stroke Scale (NIHSS) to a score of ≤4 within 24 h. PWI and DWI lesion volumes were measured on ADC (ADC < 80%) and time to peak maps (TTP > +4 s). Recanalization was assessed by MRA after 24 h. Final infarct volumes were defined on T2 weighted images at day seven. Outcome was assessed after 90 days using modified Rankin Scale (mRS) and Barthel Index (BI). Results: SSD was present in 14 of 104 patients. Initial DWI and PWI lesion volumes were smaller in SSD patients – ADC < 80%: 8.9 (4.3–20.5) vs. 30 (0–266.7) ml; TTP > +4 s: 91.6 (29.7–205.8) vs. 131.5 (0–311.5) ml. Early recanalization was associated with SSD resulted in smaller final infarct volumes (11.9 (2.4–25.9) vs. 47.7 (1.2–288.5)). All SSD patients were independent at day 90 (mRS 0 (0–2); BI 100). Conclusion: The clinical syndrome of SSD is reflected by a typical MRI pattern with small initial DWI and PWI lesion volumes, timely recanalization and small final infarct volumes.

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Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging and Clinical Patterns of Patients with ‘Spectacular Shrinking Deficit’ after Acute Middle Cerebral Artery Stroke

Kraemer

Thomalla²,

Soennichsen³

et al. 2005

Cerebrovasc Dis

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“…13,14 Patients with acute ischemic stroke symptoms of Յ24 hours in duration were randomized at 37 centers in the United States. The study population for this analysis included all 1275 intent-to-treat patients randomized in TOAST.…”

Section: Methodsmentioning

confidence: 99%

Effect of Prior Aspirin Use on Stroke Severity in the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

Wilterdink

Bendixen

Adams

et al. 2001

Stroke

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Background and Purpose-Although the efficacy of aspirin in reducing stroke incidence is clear, its role in reducing stroke severity is disputed. This study compares stroke severity between patients who did or did not take aspirin in the week before stroke and enrollment in the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Methods-Of 1275 patients randomized, 509 reported aspirin use in the week before stroke; 766 did not. Clinical stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Supplementary Motor Examination (SME) at trial entry and at 3 months. Using these scales, we compared the categorization of stroke severity (mild, moderate, and severe) and mean scores between aspirin users and nonusers. Results-The difference in distribution of baseline NIHSS scores was statistically significant between aspirin users and nonusers (Pϭ0.006), with a greater percentage of milder strokes among aspirin users. The difference in mean baseline NIHSS scores was also significantly lower in aspirin users (8.2) and nonusers (9.3) (Pϭ0.003). The distribution of baseline SME scores and mean SME scores also showed lower stroke severity in aspirin users than in nonusers (Pϭ0.048 and Pϭ0.004, respectively). At 3 months, differences in stroke severity measured by the SME but not the NIHSS remained statistically significant. Seven-day and 3-month mortality did not differ significantly. Conclusions-In

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“…In addition, cerebrovascular ultrasound evaluation and transthoracic or transesophageal echocardiogram was performed as appropriate. Assessment of stroke subtype using modified Stroke Data Bank criteria 12 was determined by consensus of stroke neurologists, using all available information, as previously described. 13,14 …”

Section: Index Evaluationmentioning

confidence: 99%

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

Dhamoon

Tai

Boden‐Albala

et al. 2007

Stroke

125

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Background and Purpose-In national guidelines, absolute long-term risk of myocardial infarction (MI) or coronary death determines target low-density lipoprotein levels, but stroke patients are not explicitly addressed. We determined the absolute 5-year risk of cardiovascular outcomes and their predictors after first ischemic stroke in a multiethnic cohort. Methods-A population-based cohort of first ischemic stroke patients Ն40 years old was prospectively followed annually for recurrent stroke, MI and cause-specific mortality. Kaplan-Meier 5-year risks for MI or vascular death (primary outcome), and other cardiovascular events, were calculated. Univariate and multivariate Cox proportional hazards models were used to calculate hazard ratios and 95% CI for predictors of cardiovascular outcomes. Results-Mean age (nϭ655) was 69.7Ϯ12.7 years; 55.4% of participants were women, and 51.3% Hispanic. The 5-year risk of MI or vascular death was 17.4% (95% CI, 14.2% to 20.6%). Independent historical predictors of MI or vascular death were age Ͼ70 years (hazard ratio 1.62, 1.07 to 2.44), history of coronary artery disease (hazard ratio 1.76, 1.13 to 2.74), and atrial fibrillation (hazard ratio 1.76, 1.05 to 2.94). In the lowest risk group, those Յ70 years old without coronary artery disease, 5-year risk of MI or vascular death was 9.7%. Conclusions-The absolute risk of MI or vascular death after ischemic stroke, even in those without high-risk features, approximates levels used by national organizations to designate groups of patients at high risk of vascular events. The comparability of levels of absolute risk among stroke and cardiac patients may have treatment implications. (Stroke.

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Design of the trial of Org 10172 in acute stroke treatment (TOAST)

Cited by 61 publications

References 36 publications

Magnetic Resonance Imaging and Clinical Patterns of Patients with ‘Spectacular Shrinking Deficit’ after Acute Middle Cerebral Artery Stroke

Magnetic Resonance Imaging and Clinical Patterns of Patients with ‘Spectacular Shrinking Deficit’ after Acute Middle Cerebral Artery Stroke

Effect of Prior Aspirin Use on Stroke Severity in the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

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