The Los Angeles Motor Scale is independently associated with cerebral blood flow < 30% volume in large vessel occlusions.

Abstract

Background and purpose: Mechanical thrombectomy (MT) is the treatment standard for large vessel occlusion (LVO) stroke. Under current guidelines, only patients with smaller ischemic core volumes (ICV) are eligible for MT. Thus, it is of interest to quickly estimate ICV in stroke patients. The Los Angeles Motor Scale (LAMS) is a validated tool used to assess stroke severity directly in the field. This study aims to determine whether LAMS score is also associated with ICV, as defined by the CBF <30% volume on CT perfusion imaging.

Methods: We performed a retrospective, multicenter cohort study of consecutive patients presenting with LVO stroke from 9/1/2017 to 10/1/2023. The inclusion criteria were patients with (1) stroke caused by large vessel occlusion confirmed on CTA and (2) diagnostically adequate, multimodal pretreatment CT imaging. Demographic, clinical, and imaging data was collected through manual chart review. Both univariate and multivariate analyses were applied to assess associations. A p-value <.05 was considered significant.

Results: A total of 283 patients (median age: 69, IQR: 61-78) were included in the study. On multivariate logistic regression analysis, we found that lower admission LAMS score (adjusted OR: 0.511, 95% CI: 0.313-0.834, p = .007) was independently associated with a CBF <30% volume of less than 50cc.

Conclusions: Admission LAMS is an independent predictor of a CBF <30% volume of less than 50cc. This demonstrates that LAMS can be used to estimate ICV, which will aid in the early triaging of LVO patients to thrombectomy-capable centers.