Introduction:

There is lack of data on etiology and mechanism of ischemic stroke in rural Western India. The TOAST classification and ASCOD classification are validated to provide strong etiological information on ischemic stroke.

Aims and Objectives:

We aimed to review all admitted stroke patients’ data and classify the stroke etiology/mechanism based on these two classification systems [TOAST and ASCOD] to compare and contrast them.

Materials and Methods:

We retrieved clinical details of consecutive ischemic stroke patients admitted between 1 Jan 2014 to 1 July 2016 from medical records of our hospital and classified them based on the TOAST and ASCOD systems.

Results:

Based on ASCOD classification, A was present in 42% of patients (A1=21% and A2=8%), S in 44% of patients (S1= 9% and S2= 1%), C in 17% of patients (C1= 6% and C2= 4%), O in 5% of patients (O1= 5%), and D in <1% of patients. The TOAST classification showed Large Artery Atherosclerosis (33%), Small Artery Occlusion (29%), Cardioembolism (13%), Other Causes (6%), and Undetermined (18%). On ASCOD classification, there was overlap of disease between Grades 1 and 2 (3%) and when extended to Grade 3 there was overlap in 26%. The ASCOD classification’s inclusion of multiple factors revealed links between different stroke mechanisms while the TOAST classification relied heavily on a single etiological mechanism.

Conclusion: 

Stroke is a complex disease with numerous contributing factors. Considering a single factor for etiology [as in TOAST] is difficult. In comparison, ASCOD could identify significant patients with multiple stroke mechanisms. 

Key words: Stroke, TOAST, classification, ASCOD

Comparing TOAST and ASCOD systems of classification in patients with ischemic strokes in rural western India