Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping

Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping

Author Bezerra, Rodrigo de Paiva Autor UNIFESP Google Scholar
de Miranda Alves, Maramelia Araujo Autor UNIFESP Google Scholar
Conforto, Adriana Bastos Autor UNIFESP Google Scholar
Gomes Rodrigues, Daniela Laranja Autor UNIFESP Google Scholar
Silva, Gisele Sampaio Autor UNIFESP Google Scholar
Abstract Background: Cardioembolism is considered a major pathophysiological mechanism in patients with ischemic stroke (IS) and Chagas disease (CD). However, a previous study reported that other stroke subtypes are present in more than 40% of CD patients according to the TOAST classification. Therefore, the aim of our study was to evaluate the etiologic classification of stroke in patients with CD using the Causative Classification System (CCS), the ASCOD, and the TOAST classifications in a prospective cohort of patients. Methods: Patients evaluated in our outpatient clinic from 2012 to 2015 with IS and CD were included and underwent full investigation for stroke etiology. TOAST, CCS TOAST, and the ASCOD classifications were compared. Findings: We Included 32 patients (18 men; mean age 62.7 +/-10.1 years). A total of 93.8% had at least 1 vascular risk factor; the most frequent was hypertension (87.5%). According to TOAST, we defined 87.5% as having cardioembolic stroke, being 9.4% as large-artery atherosclerotic (LAA) and 3.1% as undetermined cause. Using the CCS TOAST, 62.5% were classified as cardioaortic embolism evident and 15.6% as possible, 6.3% as small artery occlusion evident and 3.1% as probable, and 12.5% as LAA evident. When ASCOD phenotyping was applied, atherosclerosis was present in 50.1% of patients (A1 = 6.3%, A3 = 43.8%), cardiac pathology in 84.4% (C1 = 62.5%, C2 = 15.6%, C3 = 6.3%), and small-vessel disease in 66% (S1 = 9.4%, S2 = 3.1%, S3 = 3.1%). Findings: In conclusion, the use of the CCS and the ASCOD phenotyping in patients with CD confirmed a high frequency of cardioembolic IS but also showed that other etiologies are prevalent, such as large-artery atherosclerosis and small-vessel occlusion.
Keywords Ischemic
stroke
Chagas
embolism
xmlui.dri2xhtml.METS-1.0.item-coverage Amsterdam
Language English
Date 2017
Published in Journal Of Stroke & Cerebrovascular Diseases. Amsterdam, v. 26, n. 12, p. 2864-2869, 2017.
ISSN 1052-3057 (Sherpa/Romeo, impact factor)
Publisher Elsevier Science Bv
Extent 2864-2869
Origin http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.07.007
Access rights Closed access
Type Article
Web of Science ID WOS:000417202400026
URI https://repositorio.unifesp.br/handle/11600/58104

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