TOAST classification

The TOAST classification is used to assign the causes ( etiologies ) of ischemic stroke . The classification was developed in 1993 for the clinical study of the same name "Trial of Org 10172 in Acute Stroke Treatment" (TOAST). It is used in a simplified form in numerous studies and in Germany in most quality assurance projects of the federal states. It is the most widely used classification system for stroke subtypes in the specialist literature and is particularly used in studies that do not deal with the treatment of stroke (e.g. the investigation of possible risk factors and epidemiological studies).

The established TOAST classification distinguishes 5 groups: " Macroangiopathy ", " Microangiopathy ", " Cardiac embolism ", "Other etiology" and "Unclear etiology". The interrater reliability , a measure of the agreement (= concordance) of the assessment results among different observers, is considered to be moderately good (kappa = 0.68) or moderate. In the original form, 6 additional categories were used.

TOAST criteria

Macroangiopathy : According to the TOAST criteria, the cause is classified as macroangiopathy if there is more than 50 percent stenosis or an occlusion of a blood vessel supplying the brain. The diagnosis should not reveal any evidence of a cardiac embolism source as the cause.
Cardiac embolic : Strokes are classified as cardioembolic infarcts if a cardiac embolic source has been identified. The evidence or the presence of atrial fibrillation , an open foramen ovale , mitral valve stenosis , cardiac thrombi , a sick sinus syndrome , an atrial myxoma or the presence of artificial or bioprosthetic heart valves is considered relevant. Infarcts in different river areas can support the classification as cardiac embolism.
Microangiopathy : Subcortical lacunar cerebral infarction can be classified under microangiopathy. Macroangiopathy according to the above criteria and a cardiac source of embolism should be excluded. The presence of high blood pressure and / or diabetes mellitus can support the classification as a microangiopathic stroke.
Other etiology : If there is evidence of vasculitis , dissection , coagulation disorder or other blood disorders , the stroke can be classified in this category.
Unclear aetiology : If no cause or several competing causes (including ESUS ) are found, this category is chosen.

Individual evidence

↑ ^a ^b ^c ^d Dirk M. Herrmann: Ischemic stroke. In: Dirk M. Hermann, Thorsten Steiner, Hans C. Diener: Vascular Neurology: Cerebral ischemia, hemorrhage, vascular malformations, vasculitis and vascular dementia. Thieme-Verlag, 1st edition, June 2010, ISBN 978-3-13-146111-7 , pp. 193-194
↑ HP Adams, BH Bendixen u. a .: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. In: Stroke . Volume 24, Number 1, January 1993, pp. 35-41. PMID 7678184 .
↑ E. Bernd Ringelstein, Darius G. Nabavi: The ischemic stroke. A practice-oriented presentation of pathophysiology, diagnostics and therapy W. Kohlhammer Verlag, 2007, ISBN 978-3-17-018853-2 , p. 25
↑ ^a ^b P. Amarenco, J. Bogousslavsky u. a .: Classification of stroke subtypes. In: Cerebrovascular diseases . Volume 27, Number 5, 2009, pp. 493-501. doi : 10.1159 / 000210432 . PMID 19342825 .
↑ Hans-Christoph Diener u. a .: Schlaganfall Georg Thieme Verlag, 2004, ISBN 978-3-13-136291-9 , p. 48
↑ LB Goldstein, MR Jones et al. a .: Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. In: Stroke; a journal of cerebral circulation. Volume 32, Number 5, May 2001, pp. 1091-1098. PMID 11340215 .
↑ JF Meschia, KM Barrett et al. a .: Interobserver agreement in the trial of org 10172 in acute stroke treatment classification of stroke based on retrospective medical record review. In: Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. Volume 15, Number 6, 2006 Nov-Dec, pp. 266-272. doi : 10.1016 / j.jstrokecerebrovasdis.2006.07.001 . PMID 17904086 . PMC 2031226 (free full text).

[Herrmann193-1] Dirk M. Herrmann: Ischemic stroke. In: Dirk M. Hermann, Thorsten Steiner, Hans C. Diener: Vascular Neurology: Cerebral ischemia, hemorrhage, vascular malformations, vasculitis and vascular dementia. Thieme-Verlag, 1st edition, June 2010, ISBN 978-3-13-146111-7 , pp. 193-194

[2] HP Adams, BH Bendixen u. a .: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. In: Stroke . Volume 24, Number 1, January 1993, pp. 35-41. PMID 7678184 .

[3] E. Bernd Ringelstein, Darius G. Nabavi: The ischemic stroke. A practice-oriented presentation of pathophysiology, diagnostics and therapy W. Kohlhammer Verlag, 2007, ISBN 978-3-17-018853-2 , p. 25

[Amarenco-4] P. Amarenco, J. Bogousslavsky u. a .: Classification of stroke subtypes. In: Cerebrovascular diseases . Volume 27, Number 5, 2009, pp. 493-501. doi : 10.1159 / 000210432 . PMID 19342825 .

[5] Hans-Christoph Diener u. a .: Schlaganfall Georg Thieme Verlag, 2004, ISBN 978-3-13-136291-9 , p. 48

[6] LB Goldstein, MR Jones et al. a .: Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. In: Stroke; a journal of cerebral circulation. Volume 32, Number 5, May 2001, pp. 1091-1098. PMID 11340215 .

[7] JF Meschia, KM Barrett et al. a .: Interobserver agreement in the trial of org 10172 in acute stroke treatment classification of stroke based on retrospective medical record review. In: Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. Volume 15, Number 6, 2006 Nov-Dec, pp. 266-272. doi : 10.1016 / j.jstrokecerebrovasdis.2006.07.001 . PMID 17904086 . PMC 2031226 (free full text).