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Techniques in Neurosurgery & Neurology

Comparison of CCS and Toast Classifications with Single Center Cases in Determining Etiological Stroke Subtypes

Submission: December 23, 2020 Published: March 23, 2021

DOI: 10.31031/TNN.2021.04.000580

ISSN 2637-7748
Volume4 Issue1


Background: Identifying the pathophysiological mechanism of stroke is important for proper treatment. Causative Classification of Stroke (CCS) and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) are the mostly used classifications for maintaining underlying pathophysiology.

Method: Documents of 2096 patients who were hospitalized with Ischemic Stroke (IS) and Transient Ischemic Attack (TIA) between 2002-2005 were reviewed retrospectively. Classifications were applied to 459 patients and others were excluded because of inadequate data. Underlying mechanisms were determined by using CCS and TOAST. We compared the classifications to each other according to the etiological findings of patients.

Objective: We aimed to find out the rates of etiologies in our study group and if one classification is superior to others to reduce the undetermined case ratio.

Result: There were 394 IS and 65 TIA patients. 9.7% of IS, 32.3% of TIA according to CCS whereas 20.1% of IS, 86.2% of TIA according to TOAST were assigned as undetermined (p<0.001). 16% Cardioembolism (CE), 50.8% large artery atherosclerosis (LAA), 10.2% small artery occlusion (SAO), 13.5% More Than One Cause (MTOC) according to CCS, whereas 14.7% CE, 42.9% LAA, 5.6% SAO, 16% MTOC according to TOAST were reported in IS %) (p<0.001, 0.684, 0.031, 0.024, 0.374, respectively). 9.2% CE, 47.7% LAA, 4.6% SAO and 6.2% MTOC were found according to CCS, whereas 1.5% CE, 9.2% LAA (p<0.001), 1.5% SAO and 1.5% MTOC according to TOAST were reported in TIA.

Conclusion: Most frequent etiology was LAA in both CCS and TOAST, whereas the least frequent were other causes. We thought that CCS reduces the proportion of undetermined etiology than TOAST in patients. We need further studies for appropriate results.

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