Stroke, Vol 24, 35-41, Copyright © 1993 by American Heart Association
HP Adams Jr, BH Bendixen, LJ Kappelle, J Biller, BB Love, DL Gordon and EE Marsh 3d
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.
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
Department of Neurology, University of Iowa, Iowa City 52242-1053.
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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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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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 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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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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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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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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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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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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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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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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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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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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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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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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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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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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 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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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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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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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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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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 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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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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J. M. Wardlaw What Is a Lacune? Stroke, November 1, 2008; 39(11): 2921 - 2922. [Full Text] [PDF]
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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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 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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 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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 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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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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 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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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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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]
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