TOAST ClassificationTOAST Classification16/05/0316/05/03Craig DouglasCraig Douglas Need For SubclassificationNeed For SubclassificationPrognosis, recurrence, aetiology and Prognosis, recurrence, aetiology and management differ between the management differ between the subtypessubtypes

!he classification of ischaemic stro"e !he classification of ischaemic stro"e according to the aetiological according to the aetiological mechanism is considered logical, mechanism is considered logical, since it is only with understanding of since it is only with understanding of the underlying mechanisms of stro"e the underlying mechanisms of stro"e that rational acute and secondary that rational acute and secondary therapies can be deployed#therapies can be deployed#

$%amford &000'$%amford &000' Classification SystemsClassification Systems!here are & systems which use !here are & systems which use aetiology as their basis(aetiology as their basis(

)*tro"e Data %an" $+ross, 1,-6')*tro"e Data %an" $+ross, 1,-6'

)!./*! $/dams, 1,,3')!./*! $/dams, 1,,3'!he main difficulty with this system !he main difficulty with this system is performing the necessary technical is performing the necessary technical e0aminations on all patientse0aminations on all patients Other Options?Other Options?$%amford et al'$%amford et al' Oxfordshire Community Stroke Oxfordshire Community Stroke ProjectProject%amford et al1 1,,1%amford et al1 1,,12ses clinical localisation of the infarct 2ses clinical localisation of the infarct topographytopographyPro3ides info1 4ore rele3ant to the Pro3ides info1 4ore rele3ant to the prognosis than to the underlying prognosis than to the underlying 3ascular pathology3ascular pathology!/C5, P/C5, 6/C5, P.C5!/C5, P/C5, 6/C5, P.C5 TOAST ClassificationTOAST Classification!here are 5 diagnostic sub)types of !here are 5 diagnostic sub)types of ischaemic stro"e(ischaemic stro"e(116arge artery atherosclerosis116arge artery atherosclerosis&1Cardioembolism&1Cardioembolism31*mall 3essel occlusion $lacunar'31*mall 3essel occlusion $lacunar'71.ther determined aetiology71.ther determined aetiology512ndetermined aetiology512ndetermined aetiology4ultiple possible aetiologies $8o16'4ultiple possible aetiologies $8o16' eterminin! TOAST eterminin! TOAST Sub"typeSub"type$9!/C*'$9!/C*' Section #a $ %istory&'mboliSection #a $ %istory&'mboli:igh ;is" *ource:igh ;is" *ource

)mechanical pros 3al3e)mechanical pros 3al3e

)/7 wee"s, ?6mon'

)CC