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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital,
Salim Harris1, Saleha Sungkar2, Al Rasyid1
1Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Insights
Large artery atherosclerosis is the most common ischemic stroke subtype in Indonesia. Key risk factors identified include diabetes for large artery atherosclerosis, hypertension for small vessel disease, and atrial fibrillation for cardioembolism.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Ischemic stroke is a major cause of death and disability globally, particularly in Indonesia.
- The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification categorizes ischemic stroke into five subtypes.
- Understanding the correlation between stroke risk factors and specific subtypes is crucial for targeted prevention and treatment.
Purpose of the Study:
- To identify the characteristics of ischemic stroke subtypes based on the TOAST classification in Indonesia.
- To determine the prevalent risk factors associated with each ischemic stroke subtype.
Main Methods:
- A retrospective, cross-sectional study was conducted.
- Data from 235 ischemic stroke patients diagnosed at Cipto Mangunkusumo Hospital between January and December 2016 were analyzed.
- Demographic data, stroke subtypes, and risk factors were documented and analyzed using bivariate and multivariate statistical methods (SPSS 23).
Main Results:
- Large artery atherosclerosis (LAA) was the most frequent subtype (59.6%), followed by small vessel disease (SVD) (26.7%).
- Hypertension was significantly associated with SVD and undetermined etiology subtypes.
- Diabetes was a significant risk factor for LAA, while atrial fibrillation was strongly linked to cardioembolism (CE).
Conclusions:
- Large artery atherosclerosis is the predominant ischemic stroke subtype in the Indonesian population studied.
- Specific risk factor associations were identified: diabetes for LAA, hypertension for SVD and undetermined etiology, and atrial fibrillation for CE.
- These findings highlight the importance of subtype-specific risk factor management in ischemic stroke patients.
Background And Purpose:
Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification.
Methods:
A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23.
Results:
235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5).
Conclusion:
LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.
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