The Comparison of TOAST, CCS, and ASCO Etiological Classifications in Ischemic Stroke Patients İskemik İnme Hastalarında TOAST, CCS ve ASCO Etiyolojik Sınıflamalarının Karşılaştırılması
Medical Journal of Bakirkoy, cilt.18, sa.2, ss.121-126, 2022 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 18 Sayı: 2
- Basım Tarihi: 2022
- Doi Numarası: 10.4274/bmj.galenos.2022.2021.12-16
- Dergi Adı: Medical Journal of Bakirkoy
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CINAHL, EMBASE
- Sayfa Sayıları: ss.121-126
- Anahtar Kelimeler: Ischemic stroke, etiological classification, TOAST
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: Classifications of stroke etiology is generally based on lesion pathology and ischemic stroke or hemorrhage were two main groups. Nowadays, most common classification is Trial of Org 10172 in Acute Stroke Treatment (TOAST) which was published in 1993. After the TOAST classification system, Causative Classification of Stroke System (CCS), Atherothrombosis, Small vessel disease, Cardiac causes, and Other uncommon causes (ASCO) classification systems were developed. The purpose of the study is to discuss whether CCS or ASCO systems can be replaced for TOAST classification system which is most commonly used to determine the stroke etiology. And to determine whether the number of patients can be decreased in an unidentified cause of the etiology group according to TOAST by these CCS or ASCO systems. Methods: Three hundred acute ischemic stroke patients hospitalized at Bakırköy Dr. Sadi Konuk Training and Research Hospital between 01.01.2016 and 30.06.2016 were evaluated retrospectively and they were assessed based on their neurological examination, laboratory findings and sub-types of stroke were identified according to TOAST, CCS, and ASCO etiology classifications. Results were compared based on TOAST, CCS, and ASCO. For comparison, obvious reasons for TOAST, obvious and potential reasons for CCS, and first and second evidence were used. Results: The mean age of 300 patients (176 male-124 female) was 67.13±14.19 years. No significant differences were detected between TOAST, CCS and ASCO systems for detecting etiological subtypes; large artery atherosclerosis, small artery disease, other determined causes or undetermined causes but significant differences were found between ASCO and CCS in determining cardioembolic subtype (p=0.002). Correlation analysis showed high and significant correlations between TOAST and CCS (r=0.765) and TOAST and ASCO (r=0.731). The correlation between CCS and ASCO (r=0.928). Conclusion: The traditional TOAST classification system, in use for a long time in determining stroke etiology, cannot be updated but it still maintains its practicality and availability compared to the new classification systems CCS and ASCO. There was no significant decrease in the number of patients in an undetermined etiology subgroup by CCS and ASCO compared to TOAST. As far as our results are concerned, CCS and ASCO systems have not superiority on TOAST.