Document Type
Article
Publication Date
6-29-2026
Abstract
INTRODUCTION: Stroke is a leading cause of neurological-related death in the Caribbean. The Dominican Republic has among the highest stroke-related mortality rates in the Americas. We aimed to determine ischemic stroke etiologies, characterize comorbidities, and describe outcomes in the Dominican Republic using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.
METHODS: We analyzed a multicenter quality registry between January 2022 and October 2024. Statistical analyses included Mann–Whitney U and Kruskal–Wallis tests with Bonferroni correction, chi-square tests, and Spearman correlation.
RESULTS: The most common stroke subtype was undetermined etiology (54.8%), followed by large artery atherosclerosis (17.2%) and cardioembolism (16.5%). Hypertension (73.8%), diabetes mellitus (47.2%), and prior stroke (19.9%) were the most prevalent risk factors. Cardioembolic stroke had the highest median NIHSS score (6). Prior stroke was associated with increased odds of large artery atherosclerosis (OR 1.53, p < 0.05). Hyperlipidemia was associated with small vessel occlusion (OR 2.14), and atrial flutter/fibrillation with cardioembolic stroke (OR 19.6). Reperfusion therapy was administered to 162 patients (16.6%): intravenous thrombolysis (57%), thrombectomy (33%), and bridging therapy (10%). Inpatient rehabilitation access was limited. Physical therapy was the most common. Modified Rankin Scale scores at discharge increased significantly across all etiologies (p < 0.001), with the greatest worsening in cardioembolic stroke (+2).
CONCLUSIONS: Most ischemic strokes were of undetermined etiology, with higher severity observed in cardioembolic stroke. Limited diagnostic workup, reperfusion therapies, and rehabilitation access highlight critical gaps in stroke care. These findings provide baseline data to inform targeted prevention and health system interventions in the Dominican Republic and similar settings.
Recommended Citation
Then, Ryna; Muñoz, Maria; Ramos, Cristina; Mota, Marcos; Sepulveda, Priscilla; José, Lisa; Suazo, Luis; Mendez, Francisco; Franco, Yahaira; González Villamán, Cosme; Gonell, Acela; Inoa, Violiza; Perue, Gillian Gordon; Colomé-Hidalgo, Manuel; and García, Nadja, "Application of TOAST Criteria, Comorbidities and Outcomes in Patients With Ischemic Stroke: Multicenter Collaboration in the Dominican Republic" (2026). Einstein Health Papers. Paper 73.
https://jdc.jefferson.edu/einsteinfp/73
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Language
English
Comments
This article, first published by Frontiers Media, is the author’s final published version in Frontiers in Stroke, Volume 5, 2026, Article number 1877826.
The published version is available at https://doi.org/10.3389/fstro.2026.1877826. Copyright © 2026 Then, Mu˜noz, Ramos, Mota, Sepulveda, Jos´e, Suazo, Mendez, Franco, Gonz´alez Villam´an, Gonell, Inoa, Perue, Colom´e-Hidalgo and García.