The Clinical Application Of CISS Classification In The Traditional Lacunar Infarction

Objective : Apply TOAST and CISS in the traditional lacunar infarction patients ,to understand the proportion of each etiology subtype and compare the difference between TOAST and CISS. Comparing with TOAST,to explore the clinical application value of CISS by determining the patient's etiology and affecting the prognosis in traditional lacunar infarction patients.Methods:Total 213 inpatients that were diagnosed with traditional lacunar infarction in the Department of Neurology in First Affiliated Hospital of Dalian Medical University from January 2010 to January 2011 were enrolled, two trained neurologists classified these patients into different etiology subtypes on the basis of past history,clinical manifestations,imaging (CT or MRI) characteristics,etiology examination results, etc, according to TOAST and CISS.Follow up three months for the situation of secondary prevention and recurrence of ischemic stroke. We select twenty patients randomly and classify them blinded using two classifications by two neurologists ,then assess the consistency of TOAST and CISS.Results:1.The etiology subtype composition according to TOAST was as follows:from high to low ,small artery occlusion 165 cases (77.47%),undetermined etiology 35 cases (16.4% ), 1arge artery atherosclerosis 9 cases (4.23%),cardio embolism 4 cases( 1.88%),other demonstrated etiology 0 cases (0.00%). The etiology subtype composition according to CISS was as follows:from high to low ,penetrating artery disease 114 cases (53.52%),1arge artery atherosclerosis 75 cases (35.21%), undetermined etiology 20 cases (9.39%), cardio embolism 4 cases (1.88%), other demonstrated etiology 0 cases( 0.00%).Comparing with TOAST, in the CISS , the portion of undetermined etiology dropped 7.01%, there was great difference statistically (P<0.05),the portion of penetrating artery disease dropped 23.95%, there was great difference statistically (P<0.01),the portion of 1arge artery atherosclerosis increased 30.98%, there was great difference statistically (P<0.01), the portion of cardio embolism and other demonstrated etiology are unchanged.2.When classifing the patients according to TOAST, 17 patients are consistent in 20 patients, the consistency rate is 85%,K=0.78. When classifing the patients according to CISS, 18 patients are consistent in 20 patients, the consistency rate is 90%,K=0.93.These result shows the two classifications both have high consistency between the researchers.3.Follow up three months for the situation of secondary prevention and recurrence of ischemic stroke ,19 patients were lost.91 patients have regulated secondary prevention , of which 2 patients died because of other disease,4 patients had recurrence of ischemic stroke .103 patients did not have regulate secondary prevention ,of which 2 patients died because of other disease,4 patient had the recurrence of ischemic stroke . 8 patients who had the recurrence of ischemic stroke were classified into 5 etiology subtypes according to CISS ,1arge artery atherosclerosis 5 cases,cardio embolism 1 cases,penetrating artery disease 1 cases,other demonstrated etiology 0 cases,undetermined etiology1 cases. The recurrence rates of different etiology subtypes were different, there was great difference statistically ,the recurrence rate of cardio embolism was the highest ,the recurrence rate of penetrating artery disease was the lowest.Conelusions:1.Traditional lacunar infarction is a multiple etiologies and Frequently-occurring mechanisms syndrome.2.In the traditional lacunar infarction patients, comparing with TOAST, in the CISS classification, the portion of undetermined etiology dropped significantly,the portion of 1arge artery atherosclerosis increased significantly, so that the etiology of lacunar infarction could be determined more accurately.CISS classification have important clinical application value in determining the etiology and affecting the prognosis of traditional lacunar infarction patients.3.Both TOAST and CISS have high consistency between the researchers.4.when the patients of traditional lacunar infarction discharged 3 months,The recurrence rates of different etiology subtypes were different, the recurrence rate of cardio embolism was the highest ,the recurrence rate of penetrating artery disease was the lowest.