The Los Angeles motor scale (LAMS) is independently associated with CT perfusion collateral status markers

Dhairya A Lakhani; Tejas R Mehta; Aneri B Balar; Manisha Koneru; Sijin Wen; Burak Berksu Ozkara; Justin Caplan; Adam A Dmytriw; Richard Wang; Hanzhang Lu; Meisam Hoseinyazdi; Mehreen Nabi; Ishan Mazumdar; Andrew Cho; Kevin Chen; Sadra Sepehri; Nathan Hyson; Risheng Xu; Victor Urrutia; Licia Luna; Argye H Hillis; Jeremy J Heit; Greg W Albers; Ansaar T Rai; Tobias D Faizy; Max Wintermark; Kambiz Nael; Vivek S Yedavalli

doi:10.1016/j.jocn.2024.05.005

The Los Angeles motor scale (LAMS) is independently associated with CT perfusion collateral status markers

J Clin Neurosci. 2024 May 11:125:32-37. doi: 10.1016/j.jocn.2024.05.005. Online ahead of print.

Authors

Dhairya A Lakhani¹, Tejas R Mehta², Aneri B Balar³, Manisha Koneru⁴, Sijin Wen⁵, Burak Berksu Ozkara⁶, Justin Caplan⁷, Adam A Dmytriw⁸, Richard Wang³, Hanzhang Lu³, Meisam Hoseinyazdi³, Mehreen Nabi³, Ishan Mazumdar³, Andrew Cho³, Kevin Chen³, Sadra Sepehri³, Nathan Hyson³, Risheng Xu³, Victor Urrutia³, Licia Luna³, Argye H Hillis⁷, Jeremy J Heit⁹, Greg W Albers⁹, Ansaar T Rai¹⁰, Tobias D Faizy¹¹, Max Wintermark⁶, Kambiz Nael¹², Vivek S Yedavalli³

Affiliations

¹ Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA. Electronic address: dhairyalakhani@gmail.com.
² Department of Neurology, University of missouri, Columbia, MO, USA.
³ Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA.
⁴ Cooper Medical School of Rowan University, Camden, NJ, USA.
⁵ Department of Biostatistics, West Virginia University, Morgantown, WV, USA.
⁶ Department of Neuroradiology, MD Anderson Medical Center, Houston, TX.
⁷ Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Radiology, Harvard Medical School, Boston, MA, USA.
⁹ Department of Neurology, Stanford University, Stanford, CA, USA.
¹⁰ Department of Neuroradiology, West Virginia University, Morgantown, WV, USA.
¹¹ Department of Radiology, Neuroendovascular Division - University Medical Center Münster, Germany.
¹² Division of Neuroradiology, Department of Radiology, University of California San Francisco, CA, USA.

PMID: 38735251
DOI: 10.1016/j.jocn.2024.05.005

Abstract

Background and aim: The Los Angeles Motor Scale (LAMS) is an objective tool that has been used to rapidly assess and predict the presence of large vessel occlusion (LVO) in the pre-hospital setting successfully in several studies. However, studies assessing the relationship between LAMS score and CT perfusion collateral status (CS) markers such as cerebral blood volume (CBV) index, and hypoperfusion intensity ratio (HIR) are sparse. Our study therefore aims to assess the association of admission LAMS score with established CTP CS markers CBV Index and HIR in AIS-LVO cases.

Materials and methods: In this prospectively collected, retrospectively reviewed analysis, inclusion criteria were as follows: a) CT angiography (CTA) confirmed anterior circulation LVO from 9/1/2017 to 10/01/2023, and b) diagnostic CT perfusion (CTP). Logistic regression analysis was performed to assess the relationship between admission LAMS with CTP CS markers HIR and CBV Index. p ≤ 0.05 was considered significant.

Results: In total, 285 consecutive patients (median age = 69 years; 56 % female) met our inclusion criteria. Multivariable logistic regression analysis adjusting for sex, age, ASPECTS, tPA, premorbid mRS, admission NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, coronary artery disease and hypertension, admission LAMS was found to be independently associated with CBV Index (adjusted OR:0.82, p < 0.01), and HIR (adjusted OR:0.59, p < 0.05).

Conclusion: LAMS is independently associated with CTP CS markers, CBV index and HIR. This finding suggests that LAMS may also provide an indirect estimate of CS.

Keywords: ASITN; Acute ischemic stroke; Collateral status; LAMS; Large Vessel Occlusion.