Cerebrovascular phenotypes with two etiological stroke classifications: comparison between TOAST and ASCO
Dr. Pablo Alonso-Singer
7 slide(s) – English – 2011-09-10
INTRODUCCION: The classifications of stroke are based on identifying their most likely cause. A new classification capable to describe a “stroke phenotyping” has been recently proposed: ASCO; A, atherosclerosis; S, small vessel disease; C, cardiac source; O, other cause. Each one is graded 1, 2, 3 (according to the degree of causality) and 0 or 9 if the disease is absent or is not possible due to insufficient workup. The main objective is to analyze and contrast the results of TOAST classification to the phenotype of cerebrovascular disease in the ASCO classification.
METHODS: Observational study of the first 30 ischemic stroke patients admitted to our Stroke Unit in 2010. The clinical records were given to two stroke expert neurologists, two general neurologists and two resident neurologists. The six observers classified each stroke patient according to TOAST and ASCO classifications.
RESULTS: ASCO classification showed more than one possible stroke phenotypes in 66-83% of strokes (minimum and maximum percentage between the six observers). ASCO could detect evidence of atherothrombotic, small vessel disease and cardiac source in 95 to 100% of the patients classified as such according to TOAST. In 80% to 94% of patients with cardiac source C1 by ASCO (definitively cause of stroke), presented scores 1-3 in the other items (A, S, O). ASCO classification reveled evidence for other stroke etiologies in most of strokes of undetermined origin by TOAST (50%-80%, 40%-75%, and 40%-99%, for atherosclerosis, cardioembolism and small vessel disease, respectively).
CONCLUSION: ASCO classification identified the principal cause of stroke and the potential burden of other diseases associated with stroke risk and ignored in other classifications.