Abstract TP41: Assessing The Relationship Between The Los Angeles Motor Scale And Computed Tomography Perfusion Parameters In Acute Ischemic Stroke Secondary To Large Vessel Occlusion

Abstract

The Los Angeles Motor Scale (LAMS) is a rapid pre-hospital scale used to predict stroke severity. LAMS has also been shown to accurately predict large vessel occlusions (LVOs), however, to date there is no study exploring whether LAMS correlates with CT perfusion (CTP) parameters used to decide mechanical thrombectomy (MT) candidacy. The aim of this study is to elucidate the potential relationship between LAMS and these CTP parameters. We retrospectively reviewed patients with LVO between September 2019 and October 2021. Patients were included if they had available CTP data and neurologic exam on admission. LAMS was documented based on EMS exam or scored retrospectively based on admission neurologic exam. CTP data was processed by RAPID (IschemaView, Menlo Park, CA) with ischemic core volume (rCBF < 30%), Tmax volume (Tmax > 6 second delay), hypoperfusion index (HI), and CBV index. Spearman’s correlations were performed between LAMS and the aforementioned CTP parameters. Eighty-five patients were included, of which 11 had intracranial internal carotid artery (ICA) occlusions, 52 had M1 occlusions, and 22 had proximal M2 occlusions. Of all patients, 26 had LAMS of 0-3, and 59 had LAMS of 4-5. In all cases, LAMS was positively correlated with CBF <30% (Correlation Coefficient (CC): 0.32, p < 0.01), Tmax > 6 s (CC:0.23, p< 0.04), HI (CC:0.27, p < 0.01), and negatively correlated with CBV index (CC:-0.24, p < 0.05). These relationships between LAMS and CBF < 30% and HI were more pronounced in M1 occlusions (CC:0.42, p< 0.01; 0.34, p< 0.01 respectively) and proximal M2 occlusions (CC:0.53, p<0.01; 0.48, p< 0.03 respectively). LAMS also correlated with Tmax > 6 s in M1 occlusions (CC:0.42, p< 0.01), and negatively correlated with CBV index in M2 occlusions (CC:-0.69, p< 0.01). There was no significant correlation between LAMS and CTP parameters in intracranial ICA occlusions. Our results indicate that LAMS is positively correlated with estimated ischemic core, perfusion deficit, and HI, and negatively correlated with CBV index in patients with LVO. Vessel based analyses reveal stronger correlations with M1 and M2 occlusions. This is the first study showing that the LAMS may be correlated with estimated ischemic core and collateral status parameters in patients with LVO.

Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke

“…Our investigation also revealed a significant association between CS and LAMS scores in patients with DMVO, marking the first documentation of this association in AIS‐DMVO to our knowledge. Previous work on the prognostic role of LAMS has primarily focused on patients with LVO, where higher LAMS scores have been associated with poor CS 11 . Compared to NIHSS, LAMS assessment can be completed more rapidly in the prehospital setting by emergency personnel, facilitating prompt patient triage and potentially enabling prioritization of transport to comprehensive stroke centers over nearby hospitals.…”