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Stroke, Vol 24, 35-41, Copyright © 1993 by American Heart Association


ARTICLES

Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment

HP Adams Jr, BH Bendixen, LJ Kappelle, J Biller, BB Love, DL Gordon and EE Marsh 3d
Department of Neurology, University of Iowa, Iowa City 52242-1053.

BACKGROUND AND PURPOSE: The etiology of ischemic stroke affects prognosis, outcome, and management. Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST). METHODS: A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies. "Possible" and "probable" diagnoses can be made based on the physician's certainty of diagnosis. The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria. The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients, first based only on clinical features and then after reviewing the results of diagnostic tests. RESULTS: The TOAST classification denotes five subtypes of ischemic stroke: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. Using this rating system, interphysician agreement was very high. The two physicians disagreed in only one patient. They were both able to reach a specific etiologic diagnosis in 11 patients, whereas the cause of stroke was not determined in nine. CONCLUSIONS: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement. This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke. Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke.


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StrokeHome page
A. D. Barreto, S. Martin-Schild, H. Hallevi, M. M. Morales, A. T. Abraham, N. R. Gonzales, K. Illoh, J. C. Grotta, and S. I. Savitz
Thrombolytic Therapy for Patients Who Wake-Up With Stroke
Stroke, March 1, 2009; 40(3): 827 - 832.
[Abstract] [Full Text] [PDF]


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StrokeHome page
E. C. Leira, A. Ahmed, D. L. Lamb, H. M. Olalde, R. C. Callison, J. C. Torner, H. P. Adams Jr, and for the AIRDOC study Investigators
Extending Acute Trials to Remote Populations: A Pilot Study During Interhospital Helicopter Transfer
Stroke, March 1, 2009; 40(3): 895 - 901.
[Abstract] [Full Text] [PDF]


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StrokeHome page
R. Mikulik, D. Goldemund, M. Reif, P. Aulicky, and P. Krupa
Outcome of Patients With Negative CT Angiography Results for Arterial Occlusion Treated With Intravenous Thrombolysis
Stroke, March 1, 2009; 40(3): 868 - 872.
[Abstract] [Full Text] [PDF]


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StrokeHome page
T. Freilinger, S. Bevan, S. Ripke, A. Gschwendtner, P. Lichtner, B. Muller-Myhsok, H. -E. Wichmann, H. S. Markus, T. Meitinger, and M. Dichgans
Genetic Variation in the Lymphotoxin-Alpha Pathway and the Risk of Ischemic Stroke in European Populations
Stroke, March 1, 2009; 40(3): 970 - 972.
[Abstract] [Full Text] [PDF]


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Neurorehabil Neural RepairHome page
A. Brodtmann, A. Puce, D. Darby, and G. Donnan
Serial Functional Imaging Poststroke Reveals Visual Cortex Reorganization
Neurorehabil Neural Repair, February 1, 2009; 23(2): 150 - 159.
[Abstract] [PDF]


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CJASNHome page
J.-M. Bugnicourt, J.-M. Chillon, Z. A Massy, S. Canaple, C. Lamy, H. Deramond, and O. Godefroy
High Prevalence of Intracranial Artery Calcification in Stroke Patients with CKD: A Retrospective Study
Clin. J. Am. Soc. Nephrol., February 1, 2009; 4(2): 284 - 290.
[Abstract] [Full Text] [PDF]


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StrokeHome page
T. Warnecke, I. Teismann, S. Oelenberg, C. Hamacher, E. B. Ringelstein, W. R. Schabitz, and R. Dziewas
The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients
Stroke, February 1, 2009; 40(2): 482 - 486.
[Abstract] [Full Text] [PDF]


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StrokeHome page
M. D. Connor, G. Modi, and C. P. Warlow
Differences in the Nature of Stroke in a Multiethnic Urban South African Population: The Johannesburg Hospital Stroke Register
Stroke, February 1, 2009; 40(2): 355 - 362.
[Abstract] [Full Text] [PDF]


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StrokeHome page
T. Imamura, Y. Doi, H. Arima, K. Yonemoto, J. Hata, M. Kubo, Y. Tanizaki, S. Ibayashi, M. Iida, and Y. Kiyohara
LDL Cholesterol and the Development of Stroke Subtypes and Coronary Heart Disease in a General Japanese Population: The Hisayama Study
Stroke, February 1, 2009; 40(2): 382 - 388.
[Abstract] [Full Text] [PDF]


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StrokeHome page
A. J. Grau, C. Barth, B. Geletneky, P. Ling, F. Palm, C. Lichy, H. Becher, and F. Buggle
Association Between Recent Sports Activity, Sports Activity in Young Adulthood, and Stroke
Stroke, February 1, 2009; 40(2): 426 - 431.
[Abstract] [Full Text] [PDF]


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StrokeHome page
J. F. Arenillas, P. Sandoval, N. Perez de la Ossa, M. Millan, C. Guerrero, D. Escudero, L. Dorado, E. Lopez-Cancio, J. Castillo, and A. Davalos
The Metabolic Syndrome Is Associated With a Higher Resistance to Intravenous Thrombolysis for Acute Ischemic Stroke in Women Than in Men
Stroke, February 1, 2009; 40(2): 344 - 349.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
Y. Bejot, D. B. Salem, G. V. Osseby, G. Couvreur, J. Durier, C. Marie, Y. Cottin, T. Moreau, and M. Giroud
Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006
Neurology, January 27, 2009; 72(4): 346 - 353.
[Abstract] [Full Text] [PDF]


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Arch Intern MedHome page
A. Tsutsumi, K. Kayaba, K. Kario, and S. Ishikawa
Prospective Study on Occupational Stress and Risk of Stroke
Arch Intern Med, January 12, 2009; 169(1): 56 - 61.
[Abstract] [Full Text] [PDF]


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StrokeHome page
G. M. Sare, P. M.W. Bath, L. J. Gray, T. Moulin, F. Woimant, T. England, C. Geeganage, H. Christensen, P. P. De Deyn, D. Leys, et al.
The Relationship Between Baseline Blood Pressure and Computed Tomography Findings in Acute Stroke: Data From the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)
Stroke, January 1, 2009; 40(1): 41 - 46.
[Abstract] [Full Text] [PDF]


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StrokeHome page
D. Calvet, E. Touze, C. Oppenheim, G. Turc, J.-F. Meder, and J.-L. Mas
DWI Lesions and TIA Etiology Improve the Prediction of Stroke After TIA
Stroke, January 1, 2009; 40(1): 187 - 192.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Kubo, J. Hata, Y. Doi, Y. Tanizaki, M. Iida, and Y. Kiyohara
Secular Trends in the Incidence of and Risk Factors for Ischemic Stroke and Its Subtypes in Japanese Population
Circulation, December 16, 2008; 118(25): 2672 - 2678.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
M. Castellanos, T. Sobrino, S. Pedraza, O. Moldes, J. M. Pumar, Y. Silva, J. Serena, M. Garcia-Gil, J. Castillo, and A. Davalos
High plasma glutamate concentrations are associated with infarct growth in acute ischemic stroke
Neurology, December 2, 2008; 71(23): 1862 - 1868.
[Abstract] [Full Text] [PDF]


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J. Neurol. Neurosurg. PsychiatryHome page
Y Bejot, M Caillier, D Ben Salem, G Couvreur, O Rouaud, G-V Osseby, J Durier, C Marie, T Moreau, and M Giroud
Ischaemic stroke subtypes and associated risk factors: a French population based study
J. Neurol. Neurosurg. Psychiatry, December 1, 2008; 79(12): 1344 - 1348.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
M. D. Hill
What Kind of Stroke Is It?
Clin. Chem., December 1, 2008; 54(12): 1943 - 1944.
[Full Text] [PDF]


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Clin. Chem.Home page
M. Nybo, S. P. Johnsen, C. Dethlefsen, K. Overvad, A. Tjonneland, J. O. L. Jorgensen, and L. M. Rasmussen
Lack of Observed Association between High Plasma Osteoprotegerin Concentrations and Ischemic Stroke Risk in a Healthy Population
Clin. Chem., December 1, 2008; 54(12): 1969 - 1974.
[Abstract] [Full Text] [PDF]


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StrokeHome page
A. D. Barreto, K. C. Albright, H. Hallevi, J. C. Grotta, E. A. Noser, A. M. Khaja, H. M. Shaltoni, N. R. Gonzales, K. Illoh, S. Martin-Schild, et al.
Thrombus Burden Is Associated With Clinical Outcome After Intra-Arterial Therapy for Acute Ischemic Stroke
Stroke, December 1, 2008; 39(12): 3231 - 3235.
[Abstract] [Full Text] [PDF]


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StrokeHome page
N. Mehta, K. Uchino, S. Fakhran, M. A. Sattar, B. F. Branstetter IV, K. Au, J. S. Navratil, B. Paul, M. Lee, K. M. Gallagher, et al.
Platelet C4d Is Associated With Acute Ischemic Stroke and Stroke Severity
Stroke, December 1, 2008; 39(12): 3236 - 3241.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
A. H. Tayal, M. Tian, K. M. Kelly, S. C. Jones, D. G. Wright, D. Singh, J. Jarouse, J. Brillman, S. Murali, and R. Gupta
Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke
Neurology, November 18, 2008; 71(21): 1696 - 1701.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
S. Muhammad, W. Barakat, S. Stoyanov, S. Murikinati, H. Yang, K. J. Tracey, M. Bendszus, G. Rossetti, P. P. Nawroth, A. Bierhaus, et al.
The HMGB1 Receptor RAGE Mediates Ischemic Brain Damage
J. Neurosci., November 12, 2008; 28(46): 12023 - 12031.
[Abstract] [Full Text] [PDF]


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StrokeHome page
A. P. Kansagra and E. C. Wong
Quantitative Assessment of Mixed Cerebral Vascular Territory Supply With Vessel Encoded Arterial Spin Labeling MRI
Stroke, November 1, 2008; 39(11): 2980 - 2985.
[Abstract] [Full Text] [PDF]


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StrokeHome page
J. M. Wardlaw
What Is a Lacune?
Stroke, November 1, 2008; 39(11): 2921 - 2922.
[Full Text] [PDF]


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StrokeHome page
U. Khan, C. Crossley, L. Kalra, A. Rudd, C. D.A. Wolfe, P. Collinson, and H. S. Markus
Homocysteine and Its Relationship to Stroke Subtypes in a UK Black Population: The South London Ethnicity and Stroke Study
Stroke, November 1, 2008; 39(11): 2943 - 2949.
[Abstract] [Full Text] [PDF]


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Cleveland Clinic Journal of MedicineHome page
M. BAIN, A. M. MOHEET, and P. RASMUSSEN
Which patients benefit from carotid stenting? What recent trials show
Cleveland Clinic Journal of Medicine, October 1, 2008; 75(10): 714 - 720.
[Abstract] [Full Text] [PDF]


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Mayo Clin Proc.Home page
K. Fatema, K. R. Bailey, G. W. Petty, I. Meissner, M. Osranek, A. A. Alsaileek, B. K. Khandheria, T. S. Tsang, and J. B. Seward
Increased Left Atrial Volume Index: Potent Biomarker for First-Ever Ischemic Stroke
Mayo Clin. Proc., October 1, 2008; 83(10): 1107 - 1114.
[Abstract] [Full Text] [PDF]


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NEJMHome page
R. L. Sacco, H.-C. Diener, S. Yusuf, D. Cotton, S. Ounpuu, W. A. Lawton, Y. Palesch, R. H. Martin, G. W. Albers, P. Bath, et al.
Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke
N. Engl. J. Med., September 18, 2008; 359(12): 1238 - 1251.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. R. Di Tullio, S. Homma, Z. Jin, and R. L. Sacco
Aortic Atherosclerosis, Hypercoagulability, and Stroke: The APRIS (Aortic Plaque and Risk of Ischemic Stroke) Study
J. Am. Coll. Cardiol., September 2, 2008; 52(10): 855 - 861.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
S. Kohsaka, Z. Jin, T. Rundek, B. Boden-Albala, S. Homma, R. L. Sacco, and M. R. Di Tullio
Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study.
J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 617 - 623.
[Abstract] [Full Text] [PDF]


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StrokeHome page
S. B. Coutts, M. D. Hill, C. R. Campos, Y. B. Choi, S. Subramaniam, J. C. Kosior, A. M. Demchuk, and for the VISION study group
Recurrent Events in Transient Ischemic Attack and Minor Stroke: What Events Are Happening and to Which Patients?
Stroke, September 1, 2008; 39(9): 2461 - 2466.
[Abstract] [Full Text] [PDF]


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StrokeHome page
F. J. Carod-Artal, L. F. Coral, D. S. Trizotto, and C. M. Moreira
The Stroke Impact Scale 3.0: Evaluation of Acceptability, Reliability, and Validity of the Brazilian Version
Stroke, September 1, 2008; 39(9): 2477 - 2484.
[Abstract] [Full Text] [PDF]