缺血性卒中的分型—从原始TOAST到ASCO分型

Classification of Ischemic Stroke Subtypes——From Original TOAST to ASCO

卒中分型是针对各种不同类型缺血性卒中诊断与治疗的基础,对于卒中的基础研究与临床应用也是不可或缺的工具。目前最为广泛使用的分型系统就是急性卒中OrgL10172台疗试验(trialof org10172 in acute stroke treatment,TOAST)分型。随着医学影像技术的进步与流行病学研究的发展,为了更精确的卒中分型,学者陆续提出修订TOAST的版本,因而有基于停止卒中研究(stop strokestudy,SSS)提出的SSS-TOAST与韩国改良-TOAST的产生。而新发展出的ASCO分型系统,在决定最可能卒中分型的同时,也同时保留了其他较不可能病因的信息,因此可能对于卒中复发的预防与研究是很好的工具。迄今仍没有一个十全十美的缺血性卒中分型系统,本研究探讨各个卒中分型系统的特性,分析其在诊断卒中时的优缺点。以此为基础,希望未来能发展出适合中国人的缺血性卒中分型系统。

The fundamental goal of ischemic stroke classification is to generate correct diagnosis and treatment in subgroups with discrete features. It is critical to both basic research and clinical practice. The Trial of Org10172 in Acute Stroke Treatment （TOAST） classification system has become the most widely accepted tool to categorize stroke subtype in recent literature. With the advances in stroke imaging and epidemiological studies, several classification systems, such as STOP Stroke Study （SSS）-TOAST and Korean TOAST, have been devised to enhance the accuracy of original TOAST. The newly developed ASCO （A for atherosclerosis, S for small vessel disease, C for cardiac source, O for other cause） classification is tried to identify the most likely etiology without neglecting mixed phenotypes. Therefore, the ASCO system is probable a suitable tool for evaluating secondary stroke prevention and conducting clinical trials. Until now, there is no perfect ischemic stroke classification system. This review article highlights the major classification systems that have benefits and limitations in etiologic stroke evaluation. On the basis of the current understanding, we are looking forward to an innovative classification system that fits to the Chinese populations.