Etiological classification of ischemic stroke in young patients: a comparative study of TOAST, CCS, and ASCO

被引:24
作者
Gokcal, Elif [1 ]
Niftaliyev, Elvin [1 ]
Asil, Talip [1 ]
机构
[1] Bezmialem Vakif Univ, Tip Fak Hastanesi, Istanbul, Turkey
关键词
Young ischemic stroke; Classification; S-C-O; CAUSATIVE CLASSIFICATION; RISK-FACTORS; AGED; 15; DIAGNOSIS; SUBTYPE; SYSTEM; ADULTS; POPULATION;
D O I
10.1007/s13760-017-0813-8
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Analysis of stroke subtypes is important for making treatment decisions and prognostic evaluations. The TOAST classification system is most commonly used, but the CCS and ASCO classification systems might be more useful to identify stroke etiologies in young patients whose strokes have a wide range of different causes. In this manuscript, we aim to compare the differences in subtype classification between TOAST, CCS, and ASCO in young stroke patients. The TOAST, CCS, and ASCO classification schemes were applied to 151 patients with ischemic stroke aged 18-49 years old and the proportion of subtypes classified by each scheme was compared. For comparison, determined etiologies were defined as cases with evident and probable subtypes when using the CCS scheme and cases with grade 1 and 2 subtypes but no other grade 1 subtype when using the ASCO scheme. The McNemar test with Bonferroni correction was used to assess significance. By TOAST, 41.1% of patients' stroke etiology was classified as undetermined etiology, 19.2% as cardioembolic, 13.2% as large artery atherosclerosis, 11.3% as small vessel occlusion, and 15.2% as other causes. Compared with TOAST, both CCS and ASCO assigned fewer patients to the undetermined etiology group (30.5% p < 0.001 and 26.5% p < 0.001, respectively) and assigned more patients to the small vessel occlusion category (19.9%, p < 0.001, and 21.9%, p < 0.001, respectively). Additionally, both schemes assigned more patients to the large artery atherosclerosis group (15.9 and 16.6%, respectively). The proportion of patients assigned to either the cardioembolic or the other causes etiology did not differ significantly between the three schemes. Application of the CCS and ASCO classification schemes in young stroke patients seems feasible, and using both schemes may result in fewer patients being classified as undetermined etiology. New studies with more patients and a prospective design are needed to explore this topic further.
引用
收藏
页码:643 / 648
页数:6
相关论文
共 23 条
  • [1] CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL
    ADAMS, HP
    BENDIXEN, BH
    KAPPELLE, LJ
    BILLER, J
    LOVE, BB
    GORDON, DL
    MARSH, EE
    KASE, CS
    WOLF, PA
    BABIKIAN, VL
    LICATAGEHR, EE
    ALLEN, N
    BRASS, LM
    FAYAD, PB
    PAVALKIS, FJ
    WEINBERGER, JM
    TUHRIM, S
    RUDOLPH, SH
    HOROWITZ, DR
    BITTON, A
    MOHR, JP
    SACCO, RL
    CLAVIJO, M
    ROSENBAUM, DM
    SPARR, SA
    KATZ, P
    KLONOWSKI, E
    CULEBRAS, A
    CAREY, G
    MARTIR, NI
    FICARRA, C
    HOGAN, EL
    CARTER, T
    GURECKI, P
    MUNTZ, BK
    RAMIREZLASSEPAS, M
    TULLOCH, JW
    QUINONES, MR
    MENDEZ, M
    ZHANG, SM
    ALA, T
    JOHNSTON, KC
    ANDERSON, DC
    TARREL, RM
    NANCE, MA
    BUDLIE, SR
    DIERICH, M
    HELGASON, CM
    HIER, DB
    SHAPIRO, RA
    [J]. STROKE, 1993, 24 (01) : 35 - 41
  • [2] New Approach to Stroke Subtyping: The A-S-C-O (Phenotypic) Classification of Stroke
    Amarenco, P.
    Bogousslavsky, J.
    Caplan, L. R.
    Donnan, G. A.
    Hennerici, M. G.
    [J]. CEREBROVASCULAR DISEASES, 2009, 27 (05) : 502 - 508
  • [3] Classification of Stroke Subtypes
    Amarenco, P.
    Bogousslavsky, J.
    Caplan, L. R.
    Donnan, G. A.
    Hennerici, M. G.
    [J]. CEREBROVASCULAR DISEASES, 2009, 27 (05) : 493 - 501
  • [4] The Causative Classification of Stroke system An international reliability and optimization study
    Arsava, E. M.
    Ballabio, E.
    Benner, T.
    Cole, J. W.
    Delgado-Martinez, M. P.
    Dichgans, M.
    Fazekas, F.
    Furie, K. L.
    Illoh, K.
    Jood, K.
    Kittner, S.
    Lindgren, A. G.
    Majersik, J. J.
    Macleod, M. J.
    Meurer, W. J.
    Montaner, J.
    Olugbodi, A. A.
    Pasdar, A.
    Redfors, P.
    Schmidt, R.
    Sharma, P.
    Singhal, A. B.
    Sorensen, A. G.
    Sudlow, C.
    Thijs, V.
    Worrall, B. B.
    Rosand, J.
    Ay, H.
    [J]. NEUROLOGY, 2010, 75 (14) : 1277 - 1284
  • [5] A computerized algorithm for etiologic classification of ischemic stroke - The causative classification of stroke system
    Ay, Hakan
    Benner, Thomas
    Arsava, E. Murat
    Furie, Karen L.
    Singhal, Aneesh B.
    Jensen, Matt B.
    Ayata, Cenk
    Towfighi, Amytis
    Smith, Eric E.
    Chong, Ji Y.
    Koroshetz, Walter J.
    Sorensen, A. Gregory
    [J]. STROKE, 2007, 38 (11) : 2979 - 2984
  • [6] Ischemic Stroke in Young Adults Risk Factors, Subtypes, and Prognosis
    Balci, Kemal
    Utku, Ufuk
    Asil, Talip
    Celik, Yahya
    [J]. NEUROLOGIST, 2011, 17 (01) : 16 - 20
  • [7] Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study
    Barlas, N. Yesilot
    Putaala, J.
    Waje-Andreassen, U.
    Vassilopoulou, S.
    Nardi, K.
    Odier, C.
    Hofgart, G.
    Engelter, S.
    Burow, A.
    Mihalka, L.
    Kloss, M.
    Ferrari, J.
    Lemmens, R.
    Coban, O.
    Haapaniemi, E.
    Maaijwee, N.
    Rutten-Jacobs, L.
    Bersano, A.
    Cereda, C.
    Baron, P.
    Borellini, L.
    Valcarenghi, C.
    Thomassen, L.
    Grau, A. J.
    Palm, F.
    Urbanek, C.
    Tuncay, R.
    Durukan Tolvanen, A.
    van Dijk, E. J.
    de Leeuw, F. -E.
    Thijs, V.
    Greisenegger, S.
    Vemmos, K.
    Lichy, C.
    Bereczki, D.
    Csiba, L.
    Michel, P.
    Leys, D.
    Spengos, K.
    Naess, H.
    Tatlisumak, T.
    Bahar, S. Z.
    [J]. EUROPEAN JOURNAL OF NEUROLOGY, 2013, 20 (11) : 1431 - 1439
  • [8] Stroke in young patients: Etiopathogenesis and risk factors in different age classes
    Cerrato, P
    Grasso, M
    Imperiale, D
    Priano, L
    Baima, C
    Giraudo, M
    Rizzuto, A
    Azzaro, C
    Lentini, A
    Bergamasco, B
    [J]. CEREBROVASCULAR DISEASES, 2004, 18 (02) : 154 - 159
  • [9] Ischemic stroke in young adults: classification and risk factors
    Chatzikonstantinou, Anastasios
    Wolf, Marc E.
    Hennerici, Michael G.
    [J]. JOURNAL OF NEUROLOGY, 2012, 259 (04) : 653 - 659
  • [10] Classifying Ischemic Stroke, from TOAST to CISS
    Chen, Pei-Hao
    Gao, Shan
    Wang, Yong-Jun
    Xu, An-Ding
    Li, Yan-Sheng
    Wang, David
    [J]. CNS NEUROSCIENCE & THERAPEUTICS, 2012, 18 (06) : 452 - 456