Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
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Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke? / Simonsen, Sofie A.; West, Anders S.; Heiberg, Adam; Wolfram, Frauke; Jennum, Poul J.; Iversen, Helle K.
In: Journal of Personalized Medicine, Vol. 12, No. 3, 496, 03.2022.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
AU - Simonsen, Sofie A.
AU - West, Anders S.
AU - Heiberg, Adam
AU - Wolfram, Frauke
AU - Jennum, Poul J.
AU - Iversen, Helle K.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - ischemic stroke
KW - stroke
KW - classification
KW - magnetic resonance imaging
KW - large vessel disease
KW - small vessel disease
KW - personalized medicine
KW - ANKLE-BRACHIAL INDEX
KW - SMALL-VESSEL DISEASE
KW - VASCULAR RISK-FACTORS
KW - ETIOLOGIC CLASSIFICATION
KW - CAUSATIVE CLASSIFICATION
KW - ENDOTHELIAL FUNCTION
KW - MORTALITY
KW - SUBTYPE
KW - SCORE
U2 - 10.3390/jpm12030496
DO - 10.3390/jpm12030496
M3 - Journal article
C2 - 35330495
VL - 12
JO - Journal of Personalized Medicine
JF - Journal of Personalized Medicine
SN - 2075-4426
IS - 3
M1 - 496
ER -
ID: 313875039