Gökçal Elif, Niftaliyev Elvin, Asil Talip
Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, Istanbul, Turkey.
Acta Neurol Belg. 2017 Sep;117(3):643-648. doi: 10.1007/s13760-017-0813-8. Epub 2017 Jul 8.
Analysis of stroke subtypes is important for making treatment decisions and prognostic evaluations. The TOAST classification system is most commonly used, but the CCS and ASCO classification systems might be more useful to identify stroke etiologies in young patients whose strokes have a wide range of different causes. In this manuscript, we aim to compare the differences in subtype classification between TOAST, CCS, and ASCO in young stroke patients. The TOAST, CCS, and ASCO classification schemes were applied to 151 patients with ischemic stroke aged 18-49 years old and the proportion of subtypes classified by each scheme was compared. For comparison, determined etiologies were defined as cases with evident and probable subtypes when using the CCS scheme and cases with grade 1 and 2 subtypes but no other grade 1 subtype when using the ASCO scheme. The McNemar test with Bonferroni correction was used to assess significance. By TOAST, 41.1% of patients' stroke etiology was classified as undetermined etiology, 19.2% as cardioembolic, 13.2% as large artery atherosclerosis, 11.3% as small vessel occlusion, and 15.2% as other causes. Compared with TOAST, both CCS and ASCO assigned fewer patients to the undetermined etiology group (30.5% p < 0.001 and 26.5% p < 0.001, respectively) and assigned more patients to the small vessel occlusion category (19.9%, p < 0.001, and 21.9%, p < 0.001, respectively). Additionally, both schemes assigned more patients to the large artery atherosclerosis group (15.9 and 16.6%, respectively). The proportion of patients assigned to either the cardioembolic or the other causes etiology did not differ significantly between the three schemes. Application of the CCS and ASCO classification schemes in young stroke patients seems feasible, and using both schemes may result in fewer patients being classified as undetermined etiology. New studies with more patients and a prospective design are needed to explore this topic further.
分析中风亚型对于制定治疗决策和进行预后评估至关重要。TOAST分类系统是最常用的，但CCS和ASCO分类系统可能在识别中风病因广泛多样的年轻患者的中风病因方面更有用。在本手稿中，我们旨在比较TOAST、CCS和ASCO在年轻中风患者中亚型分类的差异。将TOAST、CCS和ASCO分类方案应用于151例年龄在18至49岁的缺血性中风患者，并比较每种方案分类的亚型比例。为了进行比较，确定的病因在使用CCS方案时定义为具有明确和可能亚型的病例，在使用ASCO方案时定义为具有1级和2级亚型但无其他1级亚型的病例。使用经Bonferroni校正的McNemar检验来评估显著性。根据TOAST分类，41.1%的患者中风病因被归类为病因不明，19.2%为心源性栓塞，13.2%为大动脉粥样硬化，11.3%为小血管闭塞，15.2%为其他原因。与TOAST相比，CCS和ASCO将更少的患者归入病因不明组（分别为30.5%，p<0.001和26.5%，p<0.001），并将更多的患者归入小血管闭塞类别（分别为19.9%，p<0.001和21.9%，p<0.001）。此外，两种方案都将更多患者归入大动脉粥样硬化组（分别为15.9%和16.6%）。在三种方案中，归入心源性栓塞或其他病因的患者比例没有显著差异。CCS和ASCO分类方案在年轻中风患者中的应用似乎是可行的，并且使用这两种方案可能会使被归类为病因不明的患者减少。需要进行更多患者参与的前瞻性新研究来进一步探索这个话题。
