Simonsen Sofie A, West Anders S, Heiberg Adam V, Wolfram Frauke, Jennum Poul J, Iversen Helle K
Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark.
Department of Radiology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark.
J Pers Med. 2022 Mar 19;12(3):496. doi: 10.3390/jpm12030496.
Pathophysiologic classification of ischemic stroke is essential to a personalized approach to stroke treatment. The Trial of Org 101072 in Acute Stroke Treatment (TOAST) classification is the most frequently used tool to classify index ischemic strokes. We aimed to assess presence of small and large vessel disease markers across the TOAST groups. In an observational study, 99 ischemic stroke patients were consecutively included and classified according to TOAST. The assessment was supplemented with cerebral small vessel disease (SVD) score, based on Magnetic Resonance Imaging (MRI), and tests for carotid atherosclerosis, ankle−brachial index (ABI), estimated glomerular filtration rate (eGFR), and peripheral reactive hyperemia index (RHI). Markers of small and large vessel disease were present in all TOAST groups. Carotid stenosis and atrial fibrillation were associated with their respective TOAST groups (p = 0.023 and p < 0.001, respectively). We found no association between the SVD score and the small vessel occlusion TOAST group (p = 0.59), and carotid atherosclerosis (p = 0.35), RHI (p = 0.39), ABI (p = 0.20), and eGFR (p = 0.79) were not associated with TOAST groups. The TOAST classification does not provide differential information on the pathophysiologies of the ischemic stroke. An operational classification that contains quantification of each vascular pathophysiology in the individual patient is pivotal for future research and development of personalized medicine.
缺血性中风的病理生理分类对于中风治疗的个性化方法至关重要。急性中风治疗中Org 101072试验（TOAST）分类是用于对缺血性中风进行分类的最常用工具。我们旨在评估TOAST各亚组中小血管和大血管疾病标志物的存在情况。在一项观察性研究中，连续纳入99例缺血性中风患者，并根据TOAST进行分类。评估补充了基于磁共振成像（MRI）的脑小血管疾病（SVD）评分，以及颈动脉粥样硬化、踝臂指数（ABI）、估算肾小球滤过率（eGFR）和外周反应性充血指数（RHI）的检测。所有TOAST亚组中均存在小血管和大血管疾病的标志物。颈动脉狭窄和心房颤动与其各自的TOAST亚组相关（分别为p = 0.023和p < 0.001）。我们发现SVD评分与小血管闭塞TOAST亚组之间无关联（p = 0.59），并且颈动脉粥样硬化（p = 0.35）、RHI（p = 0.39）、ABI（p = 0.20）和eGFR（p = 0.79）与TOAST亚组无关。TOAST分类并未提供关于缺血性中风病理生理学的差异信息。包含对个体患者每种血管病理生理学进行量化的操作性分类对于个性化医学的未来研究和发展至关重要。
