SPARKLE (Subtypes of Ischaemic Stroke Classification System), Incorporating Measurement of Carotid Plaque Burden: A New Validated Tool for the Classification of Ischemic Stroke Subtypes
SPARKLE (Subtypes of Ischaemic Stroke Classification System), Incorporating Measurement of Carotid Plaque Burden: A New Validated Tool for the Classification of Ischemic Stroke Subtypes
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DOI：
10.1159/000362417
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发表时间：
2014-01-01
影响因子：
5.7
通讯作者：
Spence, J. David
中科院分区：
文献类型：
--
作者：
Bogiatzi, Chrysi;Wannarong, Thapat;Spence, J. David
背景：以往的急性缺血性卒中分类系统(急性缺血性卒中病因分类系统，急性卒中治疗组织10172试验，TOAST)建立在有无颈动脉狭窄的基础上诊断大动脉疾病。然而，颈动脉斑块负荷比狭窄更能预测心血管风险。我们的目的是更新缺血性卒中亚型的定义，以提高LAD的检测，并评估一种新的分类系统的有效性和可靠性：SPARKLE(缺血性卒中分类系统的亚型)。方法：通过对临床研究资料的回顾，我们比较了三种卒中亚型：CCS、TOAST和SPEKE。我们分析了2002至2012年间在加拿大安大略省伦敦市一家短暂性脑缺血发作(TIA)紧急门诊就诊的275名出现轻微中风或短暂性脑缺血发作(TIA)的患者的随机样本。结果：SPARKE和CCS的总体诊断结果基本一致(kappa=0.75)，但在LAD、心绞痛和原因不明的卒中或短暂性脑缺血发作(TIA)的发现率上有显著差异。SPISKE的评分员间信度较高(kappa=0.76)，评分员内信度较好(kappa=0.91)。结论：SPARKLE是一种有效、可靠的分类系统，与CCS和TOAST相比具有一定的优势。将斑块负荷纳入LAD的分类增加了LAD可归因于LAD的比例，并降低了归类为“不明”病因的比例。(C)2014年S.Karger AG，巴塞尔
Background: Previous classification systems of acute ischemic stroke (Causative Classification System, CCS, of acute ischemic stroke, Trial of Org 10172 in Acute Stroke Treatment, TOAST) established the diagnosis of large artery disease (LAD) based on the presence or absence of carotid stenosis. However, carotid plaque burden is a stronger predictor of cardiovascular risk than stenosis. Our objective was to update definitions of ischemic stroke subtypes to improve the detection of LAD and to assess the validity and reliability of a new classification system: SPARKLE (Subtypes of Ischaemic Stroke Classification System). Methods: In a retrospective review of clinical research data, we compared three stroke subtype classifications: CCS, TOAST and SPARKLE. We analyzed a random sample of 275 patients presenting with minor stroke or transient ischemic attack (TIA) in an Urgent TIA Clinic in London, Ont., Canada, between 2002 and 2012. Results: There was substantial overall agreement between SPARKLE and CCS (kappa = 0.75), with significant differences in the rate of detection of LAD, cardioennbolic and undetermined causes of stroke or TIA. The inter-rater reliability of SPARKLE was substantial (kappa = 0.76) and the intra-rater reliability was excellent (kappa = 0.91). Conclusion: SPARKLE is a valid and reliable classification system, providing advantages compared to CCS and TOAST. The incorporation of plaque burden into the classification of LAD increases the proportion of cases attributable to LAD and reduces the proportion classified as being of 'undetermined' etiology. (C) 2014 S. Karger AG, Basel