[Stroke etiology and long-term need of care in ischemic stroke patients]

Abstract

About 80 % of all strokes are of ischemic origin. Among these the Trial of ORG 10 172 in Acute Stroke Treatment (TOAST) classification denotes five the etiological categories: large-artery atherosclerosis, cardioembolism, small-artery occlusion, strokes of undetermined etiology and strokes of other determined etiology, which are based on imaging and diagnostic findings. The object of research is the distribution of these TOAST categories in a demographically defined population and their impact on the need of care. The present study involves patients recruited within the population-based Erlangen Stroke Project (ESPro). The patients were analysed at time points after admission as well as 3 and 12 month after the event. results were presented as adjusted Odds Ratios (aOR). 1355 patients with a first-ever-in-a-lifetime ischemic stroke were registered in the Community of Erlangen. TOAST classification could be performed in 89 % (1206) of ischemic strokes. The etiological classification of brain infarctions resulted in 12 % large-artery atherosclerosis, 26 % cardioembolism, 24 % small-artery occlusion, 37 % strokes of undetermined etiology and 2 % strokes of other determined etiology. While 20 % of the patients were independent functionally at the Barthel index at admission, the number was 39 % after 12 month. The category large-artery atherosclerosis showed the strongest relationship with the occurring need of care. The aOR with very strong care needs 12.79 (95 % CI 3.71 -44.07) lay particularly high in comparison with an aOR of 6.95 (95 % CI 2.16 - 22.33) in the category cardioembolism. The TOAST classification provides an appropriate tool for estimating the need of care. In particular the patients in the TOAST category large-artery atherosclerosis showed a high level of a need of care at the long-term follow-up.