Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion
Background: The Los Angeles Motor Scale (LAMS) is a rapid pre-hospital scale used to predict stroke severity which has also been shown to accurately predict large vessel occlusions (LVOs). However, to date there is no study exploring whether LAMS correlates with the computed tomography perfusion (CT...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/10/3374 |
| _version_ | 1797599692556599296 |
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| author | Karissa C Arthur Shenwen Huang Julie C. Gudenkauf Alireza Mohseni Richard Wang Alperen Aslan Mehreen Nabi Meisam Hoseinyazdi Brenda Johnson Navangi Patel Victor C Urrutia Vivek Yedavalli |
| author_facet | Karissa C Arthur Shenwen Huang Julie C. Gudenkauf Alireza Mohseni Richard Wang Alperen Aslan Mehreen Nabi Meisam Hoseinyazdi Brenda Johnson Navangi Patel Victor C Urrutia Vivek Yedavalli |
| author_sort | Karissa C Arthur |
| collection | DOAJ |
| description | Background: The Los Angeles Motor Scale (LAMS) is a rapid pre-hospital scale used to predict stroke severity which has also been shown to accurately predict large vessel occlusions (LVOs). However, to date there is no study exploring whether LAMS correlates with the computed tomography perfusion (CTP) parameters in LVOs. Methods: Patients with LVO between September 2019 and October 2021 were retrospectively reviewed and included if the CTP data and admission neurologic exams were available. The LAMS was documented based on emergency personnel exams or scored retrospectively using an admission neurologic exam. The CTP data was processed by RAPID (IschemaView, Menlo Park, CA, USA) with an ischemic core volume (relative cerebral blood flow [rCBF] < 30%), time-to-maximum (Tmax) volume (Tmax > 6 s delay), hypoperfusion index (HI), and cerebral blood volume (CBV) index. Spearman’s correlations were performed between the LAMS and CTP parameters. Results: A total of 85 patients were included, of which there were 9 intracranial internal carotid artery (ICA), 53 proximal M1 branch middle cerebral artery M1, and 23 proximal M2 branch occlusions. Overall, 26 patients had LAMS 0–3, and 59 had LAMS 4–5. In total, LAMS positively correlated with CBF < 30% (Correlation Coefficient (CC): 0.32, <i>p</i> < 0.01), Tmax > 6 s (CC:0.23, <i>p</i> < 0.04), HI (CC:0.27, <i>p</i> < 0.01), and negatively correlated with the CBV index (CC:−0.24, <i>p</i> < 0.05). The relationships between LAMS and CBF were < 30% and the HI was more pronounced in M1 occlusions (CC:0.42, <i>p</i> < 0.01; 0.34, <i>p</i> < 0.01 respectively) and proximal M2 occlusions (CC:0.53, <i>p</i> < 0.01; 0.48, <i>p</i> < 0.03 respectively). The LAMS also correlated with a Tmax > 6 s in M1 occlusions (CC:0.42, <i>p</i> < 0.01), and negatively correlated with the CBV index in M2 occlusions (CC:−0.69, <i>p</i> < 0.01). There were no significant correlations between the LAMS and intracranial ICA occlusions. Conclusions: The results of our preliminary study indicate that the LAMS is positively correlated with the estimated ischemic core, perfusion deficit, and HI, and negatively correlated with the CBV index in patients with anterior circulation LVO, with stronger relationships in the M1 and M2 occlusions. This is the first study showing that the LAMS may be correlated with the collateral status and estimated ischemic core in patients with LVO. |
| first_indexed | 2024-03-11T03:37:54Z |
| format | Article |
| id | doaj.art-cca19590b073479bbae9924974d18303 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T03:37:54Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-cca19590b073479bbae9924974d183032023-11-18T01:51:51ZengMDPI AGJournal of Clinical Medicine2077-03832023-05-011210337410.3390/jcm12103374Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel OcclusionKarissa C Arthur0Shenwen Huang1Julie C. Gudenkauf2Alireza Mohseni3Richard Wang4Alperen Aslan5Mehreen Nabi6Meisam Hoseinyazdi7Brenda Johnson8Navangi Patel9Victor C Urrutia10Vivek Yedavalli11Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USADepartment of Neurology, Johns Hopkins University, Baltimore, MD 21287, USADepartment of Neurology, Johns Hopkins University, Baltimore, MD 21287, USARussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USARussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USARussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USARussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USARussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USADepartment of Neurology, Johns Hopkins University, Baltimore, MD 21287, USADepartment of Neurology, Johns Hopkins University, Baltimore, MD 21287, USADepartment of Neurology, Johns Hopkins University, Baltimore, MD 21287, USARussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USABackground: The Los Angeles Motor Scale (LAMS) is a rapid pre-hospital scale used to predict stroke severity which has also been shown to accurately predict large vessel occlusions (LVOs). However, to date there is no study exploring whether LAMS correlates with the computed tomography perfusion (CTP) parameters in LVOs. Methods: Patients with LVO between September 2019 and October 2021 were retrospectively reviewed and included if the CTP data and admission neurologic exams were available. The LAMS was documented based on emergency personnel exams or scored retrospectively using an admission neurologic exam. The CTP data was processed by RAPID (IschemaView, Menlo Park, CA, USA) with an ischemic core volume (relative cerebral blood flow [rCBF] < 30%), time-to-maximum (Tmax) volume (Tmax > 6 s delay), hypoperfusion index (HI), and cerebral blood volume (CBV) index. Spearman’s correlations were performed between the LAMS and CTP parameters. Results: A total of 85 patients were included, of which there were 9 intracranial internal carotid artery (ICA), 53 proximal M1 branch middle cerebral artery M1, and 23 proximal M2 branch occlusions. Overall, 26 patients had LAMS 0–3, and 59 had LAMS 4–5. In total, LAMS positively correlated with CBF < 30% (Correlation Coefficient (CC): 0.32, <i>p</i> < 0.01), Tmax > 6 s (CC:0.23, <i>p</i> < 0.04), HI (CC:0.27, <i>p</i> < 0.01), and negatively correlated with the CBV index (CC:−0.24, <i>p</i> < 0.05). The relationships between LAMS and CBF were < 30% and the HI was more pronounced in M1 occlusions (CC:0.42, <i>p</i> < 0.01; 0.34, <i>p</i> < 0.01 respectively) and proximal M2 occlusions (CC:0.53, <i>p</i> < 0.01; 0.48, <i>p</i> < 0.03 respectively). The LAMS also correlated with a Tmax > 6 s in M1 occlusions (CC:0.42, <i>p</i> < 0.01), and negatively correlated with the CBV index in M2 occlusions (CC:−0.69, <i>p</i> < 0.01). There were no significant correlations between the LAMS and intracranial ICA occlusions. Conclusions: The results of our preliminary study indicate that the LAMS is positively correlated with the estimated ischemic core, perfusion deficit, and HI, and negatively correlated with the CBV index in patients with anterior circulation LVO, with stronger relationships in the M1 and M2 occlusions. This is the first study showing that the LAMS may be correlated with the collateral status and estimated ischemic core in patients with LVO.https://www.mdpi.com/2077-0383/12/10/3374ischemic strokeperfusion imagingdiagnosiscollateral status |
| spellingShingle | Karissa C Arthur Shenwen Huang Julie C. Gudenkauf Alireza Mohseni Richard Wang Alperen Aslan Mehreen Nabi Meisam Hoseinyazdi Brenda Johnson Navangi Patel Victor C Urrutia Vivek Yedavalli Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion Journal of Clinical Medicine ischemic stroke perfusion imaging diagnosis collateral status |
| title | Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion |
| title_full | Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion |
| title_fullStr | Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion |
| title_full_unstemmed | Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion |
| title_short | Assessing the Relationship between LAMS and CT Perfusion Parameters in Acute Ischemic Stroke Secondary to Large Vessel Occlusion |
| title_sort | assessing the relationship between lams and ct perfusion parameters in acute ischemic stroke secondary to large vessel occlusion |
| topic | ischemic stroke perfusion imaging diagnosis collateral status |
| url | https://www.mdpi.com/2077-0383/12/10/3374 |
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