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Published on: June 2, 2023
Stroke subtype classification: a comparative study of ASCO and modified TOAST.
1Neurology Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Journal of the Neurological Sciences
|November 29, 2011
Summary
The ASCO stroke classification shows high agreement with the modified TOAST system for most causes, except for undetermined etiologies. This new system did not reduce the rate of undetermined stroke causes.
Area of Science:
- Neurology
- Clinical Epidemiology
Background:
- Accurate etiological classification of ischemic stroke is crucial for effective treatment.
- The modified TOAST criteria are widely used but may have limitations.
- The Atherosclerosis, Small vessel disease, Cardiac sources, and Other (ASCO) classification system is proposed as an improvement.
Purpose of the Study:
- To compare stroke subtype classification between the ASCO and modified TOAST systems.
- To evaluate the ASCO system's potential to improve etiological diagnosis in acute ischemic stroke.
Main Methods:
- A cohort of 425 first-time acute ischemic stroke patients was analyzed.
- Ischemic stroke causes were classified using both ASCO and modified TOAST criteria.
- Statistical analysis included the κ statistic and McNemar test to assess agreement and differences.
Main Results:
- High agreement was observed between ASCO and modified TOAST for atherosclerosis (κ>0.81) and cardiac disease (κ=0.61-0.8).
- Agreement was lower for undetermined etiology (κ=0.480).
- ASCO-1 identified atherosclerosis in 76.0%, small artery disease in 46.4%, and cardiac disease in 11.3% of patients.
Conclusions:
- The ASCO and modified TOAST classification schemes demonstrate moderate to high agreement across most stroke subtypes.
- The ASCO system did not significantly decrease the proportion of patients with undetermined stroke etiology compared to the modified TOAST.
- Further research may be needed to refine the ASCO system for undetermined cases.
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