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Comparison Study of ASCO and TOAST Classification System in Chinese Minor Stroke Patients

Xiao-Yu Xin1, Lin Cheng1,2, Zhao Yang2

  • 1Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.

Cerebrovascular Diseases (Basel, Switzerland)
|March 29, 2019
PubMed

Insights

The Atherosclerosis, Small vessel disease, Cardiac source, Others (ASCO) system provides more detailed stroke etiologies in minor stroke patients than the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. ASCO reduces the proportion of undetermined stroke causes, aiding personalized prevention strategies.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Precise pathophysiological subtype classification is crucial for preventing recurrent attacks in minor stroke patients.
  • The Atherosclerosis, Small vessel disease, Cardiac source, Others (ASCO) system is a novel phenotypic classification for stroke subtypes.
  • The ASCO system's utility in minor stroke populations requires investigation and comparison with existing methods like the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.

Purpose of the Study:

  • To investigate the impact of the ASCO criteria on minor stroke etiologies.
  • To compare the ASCO classification with the TOAST classification in minor ischemic stroke patients.
  • To evaluate the effectiveness of ASCO in identifying stroke causes compared to TOAST.

Main Methods:

  • Consecutive patients with minor ischemic stroke (NIHSS ≤3) were assessed.
  • Etiological subtyping was performed using both the ASCO and TOAST classification systems.
  • Statistical analyses included McNemar test and kappa statistic to compare the two systems.

Main Results:

  • The ASCO system identified 37 stroke etiology profiles, with atherosclerosis (A1) and small vessel disease (S1) being most frequent (51.0% and 29.5% respectively).
  • ASCO reclassified 104 of 137 patients previously categorized as 'cause undetermined' by TOAST.
  • Good to very good agreement was found between ASCO grade 1 and TOAST, except for the 'cause undetermined' category (κ = 0.470).

Conclusions:

  • The ASCO system provides a more comprehensive etiological characterization of minor stroke compared to TOAST.
  • Application of ASCO significantly decreased the proportion of patients with undetermined stroke causes.
  • The detailed insights from the ASCO system may facilitate personalized therapy and secondary prevention strategies for minor stroke patients.
Abstract

Keywords:
ASCOEtiologyMinor strokeTOAST

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