TOAST subtypes, risk factors and recurrence of ischemic stroke

Objective To analyse subtyping of iscbemic stroke by the criteria of Trial of Org 10 172 in Acute Stroke Treatment (TOAST), its distribution, and relationship between TOAST subtypes, its risk factors and recurrence. Methods Clinical data of 441 patients of ischemic stroke were collected prospectively during October 1, 2006 to September 30, 2007. All the patients were classified by TOAST criteria into five major subtypes and followed-up for one year since its first episode. Dates of its recurrence and death due to recurrence were recorded. Results All the 441 patients with ischemic stroke could be subtyped etiologically according to TOAST criteria as follows: etiology undetermined in 42.3 percent, small-vessel occlusion in 30.9 percent, large-artery atherosclerosis in 17.3 percent, cardioembolism in 9.3 percent, and others in 0.2 percent, without statistically significant difference in its gender and age distributions. Recurrence rate of iscbemic stroke in one year since its first episode for varied subtypes was 33.3 percent for cardioembolism, 14. 6 percent for etiology undetermined, 13.7 percent for large-artery atherosclerosis and 6.9 percent for small-vessel occlusion, respectively. There was no significant difference in risk factors for varied subtypes of iscbemic stroke, including history of smoking, hypertension, diabetes, cardiac disease, and serum levels of total cholesterol, low-density lipoprotein cholesterol, fihrinogen and glucose. Conclusions Varied subtypes of iscbemic stroke had different risk factors and recurrence rate by TOAST criteria, which can be used as an etiologic classification for its secondary prevention. Key words: Cerebrovascular accident;  Subtype;  Risk factors