title: Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging.
abstract: BACKGROUND
  The association between the location and the mechanism of a stroke lesion remains unclear. A diffusion-weighted imaging study may help resolve this lack of clarity.
  
  
  RESULTS
  We studied a consecutive series of 2702 acute ischemic stroke patients whose stroke lesions were confirmed by diffusion-weighted imaging and who underwent a thorough etiological investigation. The vascular territory in which an ischemic lesion was situated was identified using standard anatomic maps of the dominant arterial territories. Stroke subtype was based on the Trial of ORG 10172 in Acute Stroke Treatment, or TOAST, classification. Large-artery atherosclerosis (37.3%) was the most common stroke subtype, and middle cerebral artery (49.6%) was the most frequently involved territory. Large-artery atherosclerosis was the most common subtype for anterior cerebral, middle cerebral, vertebral, and anterior and posterior inferior cerebellar artery territory infarctions. Small vessel occlusion was the leading subtype in basilar and posterior cerebral artery territories. Cardioembolism was the leading cause in superior cerebellar artery territory. Compared with carotid territory stroke, vertebrobasilar territory stroke was more likely to be caused by small vessel occlusion (21.4% versus 30.1%, P<0.001) and less likely to be caused by cardioembolism (23.2% versus 13.8%, P<0.001). Multiple-vascular-territory infarction was frequently caused by cardioembolism (44.2%) in carotid territory and by large-artery atherosclerosis (52.1%) in vertebrobasilar territory.
  
  
  CONCLUSIONS
  Information on vascular territory of a stroke lesion may be helpful in timely investigation and accurate diagnosis of stroke etiology.
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.W.C., M.H.Y., M.S.J., M.K.H., H.J.B.).
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Neurology, Pohang St. Mary's Hospital, Pohang, Republic of Korea (S.H.P.).
authors.forename: Su Hyun
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Neurology, Youngdong Hospital, Chungcheongbuk-do, Republic of Korea (N.K.).
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ulsan University College of Medicine, Ulsan, Republic of Korea (W.J.K.).
authors.forename: Wook-Joo
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ewha Womens University Medical Center, Seoul, Republic of Korea (J.H.P.).
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji University School of Medicine, Daejeon, Republic of Korea (Y.K.).
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.W.C., M.H.Y., M.S.J., M.K.H., H.J.B.).
authors.forename: Mi Hwa
authors.initials: MH
authors.lastname: Yang
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.W.C., M.H.Y., M.S.J., M.K.H., H.J.B.).
authors.forename: Myung Suk
authors.initials: MS
authors.lastname: Jang
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.W.C., M.H.Y., M.S.J., M.K.H., H.J.B.).
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Radiology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (C.J., J.H.K.).
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Radiology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (C.J., J.H.K.).
authors.forename: Jae Hyoung
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (C.W.O.).
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea (J.W.C., M.H.Y., M.S.J., M.K.H., H.J.B.).
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000145:classification / Q000150:complications / Q000175:diagnosis; D020244:Infarction, Middle Cerebral Artery / Q000145:classification / Q000150:complications / Q000175:diagnosis; D020762:Infarction, Posterior Cerebral Artery / Q000145:classification / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000145:classification / Q000175:diagnosis* / Q000209:etiology
keywords: cerebral infarction; diffusion magnetic resonance imaging; etiology; location
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