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Application of the AHA-Proposed Cancer-Related Ischemic Stroke Classification: Reclassification and Prognostic Impact
Yasufumi Gon1,2, Tomohiro Kawano1, Hiroshi Yamagami3
1Department of Neurology, Graduate School of Medicine, the University of Osaka, Japan (Y.G., T.K., T.S., M.S.).
Stroke
|June 3, 2026
Summary
The Cancer-Related Ischemic Stroke (CRIS) classification better identifies stroke subtypes in cancer patients. This new system reveals a subgroup with significantly worse survival compared to traditional classifications.
Area of Science:
- Neurology
- Oncology
- Cardiovascular Research
Background:
- Ischemic stroke in cancer patients is complex and often cryptogenic under TOAST classification.
- The American Heart Association introduced the Cancer-Related Ischemic Stroke (CRIS) classification.
- Evaluating CRIS has clinical and prognostic significance in this patient group.
Purpose of the Study:
- To assess the clinical and prognostic implications of the CRIS classification.
- To compare CRIS with the TOAST classification in active cancer patients with ischemic stroke.
- To determine if CRIS improves etiological classification and outcome prediction.
Main Methods:
- Analysis of prospective SCAN study data including patients with ischemic stroke and active cancer.
- Reclassification of stroke subtypes using the CRIS framework after initial TOAST classification.
- Kaplan-Meier survival analysis and log-rank testing to compare outcomes.
Main Results:
- 132 patients were analyzed; 46 previously cryptogenic strokes were reclassified as CRIS.
- CRIS classification identified a subgroup with significantly worse 1-year survival (P<0.001).
- 3-month survival was 37.5% for CRIS vs. 89.2% for reclassified cryptogenic stroke.
Conclusions:
- The CRIS classification effectively reduces cryptogenic stroke under TOAST.
- CRIS enables better prognostic stratification in cancer-related ischemic stroke.
- CRIS identifies a high-risk subgroup with markedly poorer outcomes.
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