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Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?

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...

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Autores principales: Simonsen, Sofie A., West, Anders S., Heiberg, Adam V., Wolfram, Frauke, Jennum, Poul J., Iversen, Helle K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949213/
https://www.ncbi.nlm.nih.gov/pubmed/35330495
http://dx.doi.org/10.3390/jpm12030496
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author Simonsen, Sofie A.
West, Anders S.
Heiberg, Adam V.
Wolfram, Frauke
Jennum, Poul J.
Iversen, Helle K.
author_facet Simonsen, Sofie A.
West, Anders S.
Heiberg, Adam V.
Wolfram, Frauke
Jennum, Poul J.
Iversen, Helle K.
author_sort Simonsen, Sofie A.
collection PubMed
description 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.
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spelling pubmed-89492132022-03-26 Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke? Simonsen, Sofie A. West, Anders S. Heiberg, Adam V. Wolfram, Frauke Jennum, Poul J. Iversen, Helle K. J Pers Med Article 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. MDPI 2022-03-19 /pmc/articles/PMC8949213/ /pubmed/35330495 http://dx.doi.org/10.3390/jpm12030496 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Simonsen, Sofie A.
West, Anders S.
Heiberg, Adam V.
Wolfram, Frauke
Jennum, Poul J.
Iversen, Helle K.
Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
title Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
title_full Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
title_fullStr Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
title_full_unstemmed Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
title_short Is the TOAST Classification Suitable for Use in Personalized Medicine in Ischemic Stroke?
title_sort is the toast classification suitable for use in personalized medicine in ischemic stroke?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949213/
https://www.ncbi.nlm.nih.gov/pubmed/35330495
http://dx.doi.org/10.3390/jpm12030496
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