Classification of Subtype of Acute Ischemic Stroke : Definitions for Use in a Multicenter Clinical Trial

  • Adams H
  • Bendixen B
  • Kappelle L
 et al. 
  • 141

    Readers

    Mendeley users who have this article in their library.
  • 5.1k

    Citations

    Citations of this article.

Abstract

Background and Purpose: The etiology of ischemic stroke affects prognosis, outcome, and management. Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Methods: A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies. "Possible" and "probable" diagnoses can be made based on the physician's certainty testedbytwoneurologists who had not participated in the writing of the criteria. The neurologists independently used the TOAST clinicalfeaturesand then after reviewing the results of diagnostic tests. Results: The TOAST classification denotes five subtypes of ischemic stroke: 1) large-artery atheroscle- rosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. Using this rating system, interphysician agreement was very high. The two physicians disagreed in only one patient. They were both able to reach a specific etiologic diagnosis in 11 patients, whereas the cause of stroke was not determined in nine. Conclusions: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement. This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke. Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke. (Stroke 1993;24:35-41)

Author-supplied keywords

  • but definitions are
  • c ategorization of subtypes
  • cerebral ischemia
  • classification
  • clinical trials
  • had considerable study
  • hard to formulate and
  • of ischemic stroke has
  • their application for

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document

Get full text

Authors

  • H.P Adams

  • B.H Bendixen

  • L.J Kappelle

  • J. Biller

  • B.B Love

  • D.L Gordon

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free