TIA AND ACUTE ISCHEMIC STROKE: DIAGNOSTIC TESTS FOR TOAST CLASSIFICATION

2008 ◽  
pp. 101-108
Author(s):  
Disya Ratanakorn ◽  
Jesada Keandoungchun
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Tests ◽  
Toast Classification

Abstract TP159: Correlation Between Arterial Stiffness And The Severity Of Acute Cerebral Infarction

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
YEONG-BAE LEE ◽  
Joo-Hwan Park ◽  
Eunja Kim ◽  
Ki-Tae Kim ◽  
Ju Kang Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Stiffness ◽  
Acute Ischemic Stroke ◽  
Pulse Wave ◽  
Small Vessel Disease ◽  
Large Artery ◽  
Significant Difference ◽  
Initial Severity ◽  
Artery Disease ◽  
Toast Classification

Arterial stiffness is an independent predictor of cardiovascular disease and stroke and can be evaluated by measuring pulse wave velocity(PWV) between 2 sites in the arterial tree, with a higher PWV indicating stiffer arteries. Recent studies have demonstrated that arterial stiffness is associated with intracranial large artery disease and the severity of cerebral small vessel disease. The aim of this study is to clarify whether pulse wave velocity value predict initial severity of acute ischemic stroke. We enrolled consecutive patients with acute ischemic stroke. Demographic factors, laboratory data, brain imaging, neurological exam and arterial stiffness measured by brachial ankle PWV (baPWV) were evaluated on admission in all subjects. The subtype of acute ischemic stroke was classified according to the TOAST classification. All patients were categorized into two groups based on the initial severity of stroke, indicated by modified Rankin Scale(mRS). Severe group was defined as a mRS ≥ 3 at admission. Unpaired student’s t-test or Mann-whitney U-test were used to compare maximal and meanbaPWV values between two groups. We enrolled 78 patients. According to the TOAST classification, the etiology of stroke was large artery disease (LAD) in 34 patients, small vessel disease (SVD) in 23 patients, and other subtypes in 12 patients. There were 28 patients with good outcome and 41 patients with poor outcome. The maximal and mean baPWV values were significantly increased in inpatients with high mRS score (2120.17± 527.75, 1999.21 ± 437.46) compared with those with low mRS score (1751.96 ± 363.49, 1723.14 ± 353.02)(p=0.001, p=0.007). In patients with SVD subtype, there was significant difference in maximal and mean baPWVvalues between two groups (p=0.030, p=0.047), whereas there was no significant difference in baPWV in patients with LAD subtype (p=0.141, p=0.172). The main finding of our study is that arterial stiffness indicated by baPWV is associated with the initial severity of acute ischemic stroke. Because initial stroke severity is strongly associated with functional outcome of stroke, this findings suggest that measurement of baPWV may predict long-term outcome in patients with stroke especially in those with TOAST classification confirmed as SVD.

The Use of Diagnostic Tests in Patients with Acute Ischemic Stroke

2009 ◽  
Vol 18 (3) ◽  
pp. 178-184 ◽  
Author(s):  
Edward Haosheng Yu ◽  
Codrin Lungu ◽  
Ronald M. Kanner ◽  
Richard Benjamin Libman
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Tests

Comparison of the new ASCO classification with the TOAST classification in a population with acute ischemic stroke

2011 ◽  
Vol 259 (7) ◽  
pp. 1284-1289 ◽  
Author(s):  
M. E. Wolf ◽  
T. Sauer ◽  
A. Alonso ◽  
M. G. Hennerici
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Toast Classification

Abstract TP182: Early Sleep Apnea in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Cindy W Yoon ◽  
Hee-Kwon Park ◽  
Soo Jeong Kim ◽  
Eungseok Lee ◽  
Dan A Oh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Ischemic Stroke ◽  
Early Stage ◽  
Apnea Hypopnea Index ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Severe Stroke ◽  
Toast Classification ◽  
Overnight Polysomnography

Background and Purpose: Sleep apnea (SA) is emerging as a risk factor of stroke, and stroke itself can also influence the sleep. However, investigation of SA in acute ischemic stroke is scanty. We evaluated the prevalence of SA in early stage of stroke and analyzed the SA degree and ischemic stroke subtypes and severity. Methods: We prospectively performed overnight polysomnography (PSG) in consecutive acute ischemic stroke patients who were admitted to the stroke unit within 72 hours from onset. PSG was performed on the first night, and severe stroke patients who could not stand the PSG were excluded. The apnea-hypopnea index (AHI) was calculated using the total number of apneas and hypopneas per hour sleep, and categorized into mild (AHI 5-14/hour), moderate (15-29), and severe (≥ 30). Ordinal logistic regression was performed to predict the factor associated with severity of SA (no, mild, moderate and severe). Results: From Aug 2015 to March 2016, a total of 141 patients were enrolled: mean age 63.5 ± 13.3 years, 69.5% male, median (IQR) NIHSS 3 (1-6). Among them, 124 (87.9%) patients had SA (AHI ≥ 5/hour) of any degree: 41.1% mild, 21.8% moderate, and 37.1% severe. Higher NIH stroke scale was associated with SA severity ( p = 0.010). According to the stroke subtype by TOAST classification, cardioembolism was associated with more severe SA ( p = 0.043). Conclusion: SA is frequently found in acute phase of ischemic stroke. Higher degree of SA is associated with severe stroke and cardioembolic etiology.

scholarly journals Systemic Thrombolysis Data from the German Stroke Database

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 337-337
Author(s):  
Thomas Knoll ◽  
Christian Weimar ◽  
Roman L Haberl ◽  
Otto Busse ◽  
Gerhard F Hamann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Published Data ◽  
High Dose ◽  
Systemic Thrombolysis ◽  
Intravenous Heparin ◽  
Frequency Of Use ◽  
Toast Classification

118 Objectives: To present data on systemic thrombolysis for acute ischemic stroke from a cooperative database of 23 german hospitals. Methods: All admitted stroke patients in the participating centers were prospectively recruited into a 599-item database including a telephone follow-up 3 months after stroke. Findings: From 01/1998 until 11/1999, 5279 patients with acute ischemic stroke were included in the database, 205 (3.9%) had systemic thrombolysis with 0.9mg/kg rt-PA (alteplase). Three hospitals did not perform thrombolysis (range of thrombolysis rate 0–11.3%). The median age of patients was 63 years (41% female, 59% male). The median National Institutes of Health Stroke Scale Score (NIHSSS) at admission was 14. Early high dose intravenous heparin after thrombolysis was given to 61.2% of patients. The rate of intracranial parenchymal hematoma (PH) until day 3 was 6.8%. In a logistic regression model including age, hypertension before stroke, NIHSSS, level of consciousness at admission, TOAST-classification, delay of thrombolysis and high dose intravenous heparin after thrombolyisis, PH was independently associated with high dose intravenous heparin after thrombolysis (p=.031) and hypertension before stroke (p=.042). Decompressive surgery was performed in 4.4% of thrombolysis patients. The median length of stay in the documenting hospital was 13 days, 4 in the ASU and 3 in the ICU. After 90 days, a Modified Rankin Scale Score (MRS) ≤1 was observed in 26.8%, ≤2 in 42.5% of patients (follow-up rate 66%). The mortality until day 90 was 18.3%. Conclusions: These uncontrolled multicenter data confirm published data on the frequency of use of systemic thrombolysis, risk of (symptomatic) PH and 3-month-mortality. The percentage of patients with favorable outcome (MRS ≤1) is lower than in the controlled trials. Early secondary prevention with high dose i.v. heparin was associated with increased frequency of PH and should therefore be avoided.

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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