Application And Significance Of CISS Classification And TOAST Subtype On Ischemic Stroke (Attach 210 Cases Analysis)

Objective:To learn the application value of CISS classification on ischemic stroke, and to find the difference and significance between it and TOAST subtype.Methods: Retrospectively analysis 210 cases suffered from acute ischemic stroke in neurology department of the First hospital affiliated to Dalian medical university from November 6, 2009 to February 4, 2011. According to CISS and TOAST type, the patients above were classified by two doctors using blinding method. If there was skeptical classification, yet it would be determined after discussion of two doctors. Compare the constituent ratio and differences of every subclassification in two methods, and analyze the consistency between different researchers. The relationship between hs-CRP and each subtype were discussed. The rate of recurrence and mortality of each subclassification in CISS and TOAST were studied to evaluate the prognosis.Results: 1. Rank the etiology subtype of TOAST classification from high to low: large-artery atherosclerosis (n=78, 37%), small-vessel occlusion (n=66, 31%), undetermined etiology (n=46, 22%), cardioembolism (n=17, 8%), stroke of other determined etiology (n=3, 1%). Rank the etiology subtype of CISS classification from high to low: large-artery atherosclerosis (n=124, 59%), penetrating artery disease (n=42, 20%), undetermined etiology (n=24, 11%), cardiogenic stroke (n=17, 8%), other etiology (n=3, 1%). Rank the underlying mechanism of large-artery atherosclerosis from high to low: artery-to-artery embolism (n=55, 44%), parent artery (plaque or thrombosis) occluding penetrating artery (n=48, 39%), multiple mechanisms (n=19, 15%), hypoperfusion/impaired emboli clearance (n=2, 2%). 2. 210 cases of ischemic stroke were respectively classified by TOAST and CISS classification, in which subtype of 61 cases changed when choosing the other method. 3. When defining TOAST classification as diagnostic criteria, 183 cases were consistent with reality among 210 patients (consistency 87%, Kappa value is 0.82). When defining CISS classification as diagnostic criteria, 185 cases were consistent with reality among 210 patients (consistency 88%, Kappa value is 0.81). 4. There was difference between hs-CRP levels of every etiology subtypes by TOAST classification. The level of hs-CRP in cardioembolism is the highest, followed by large-artery atherosclerosis, and small-vessel occlusion is much lower. There was difference between hs-CRP levels of every etiology subclassifications by CISS classification. The level of hs-CRP in cardiogenic stroke is the highest, followed by large artery atherosclerosis, and undetermined etiology is the lowest. 5. In 3 months follow- up, there were 201 cases (9 patients lost), in which 14 patients died (7%) and 15 cases relapsed (7%). The mortality in undetermined etiology was the highest when classified by TOAST method, followed by small-vessel occlusion. The incidence of recurrence in cardioembolism was the highest, while small-vessel occlusion has the lowest relapse. When adopting CISS classification, mortality in undetermined etiology was the highest, followed by large-artery atherosclerosis. The incidence of recurrence in cardiogenic stroke was the highest and penetrating artery disease was the lowest, which was similar with the results of TOAST classification.Conclusion: 1. Not only the etiology of ischemic stroke but also the underlying mechanism of large-artery atherosclerosis can be reflected fully and accurately by CISS classification. Besides, this method can reduce the proportion of undetermined etiology, which may provide accurate basis for treatment and recurrence of ischemic stroke. 2. CISS and TOAST classification both have high consistency between researchers. 3. The subtype of CISS and TOAST classification are both correlated with level of hs-CRP. 4. When it talks about recurrence, CISS and TOAST classification have significance in some degree.