A new subtype classification of ischemic stroke based on treatment and etiologic mechanism.

A new subtype classification of ischemic stroke was developed to reflect recent therapeutic strategies as well as evolving concepts of stroke definitions and mechanisms. In 200 consecutive patients with acute ischemic stroke, the inter-rater reliability and proportion of subtypes of the new classification system were assessed and compared with those of the Trial of ORG 10172 in the Acute Stroke Treatment (TOAST) classification. The most frequent subtype of the new classification was atherothrombosis (n = 80, 40%), followed by stroke of undetermined etiology (n = 54, 27%), small artery disease (n = 33, 16.5%), cardioembolism (n = 26, 13%), and stroke of other determined etiology (n = 7, 3.5%). Three raters agreed to the stroke subtype diagnosis in 165 out of 200 cases and the overall kappa value was excellent (kappa = 0.82). The new classification system for brain infarction was easy to use and had high inter-rater reliability.

Increase in plasma matrix metalloproteinase-9 in acute stroke patients with thrombolysis failure.

BACKGROUND AND PURPOSE: Platelet-rich thrombi are resistant to thrombolytics. Matrix metalloproteinases (MMPs) may be involved in platelet aggregation and contribute to thrombolysis failure in stroke patients. METHODS: Plasma samples from 23 stroke patients who had received thrombolytics and from 47 healthy volunteers were examined for MMP-2 and MMP-9 by both enzyme-linked immunosorbent assays and zymography. RESULTS: The arteries were recanalized in 15 patients but not in the other 8. The MMP-9 plasma level was significantly higher in patients whose arteries were not recanalized. CONCLUSIONS: MMP-9 may be associated with the formation of a thrombolytics-resistant thrombus.