Abstract TMP71: The Los Angeles Motor Scale - Atrial Fibrillation (LAMS-AF) Score is Superior to LAMS in Predicting Large Vessel Occlusion

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Priya Narwal ◽  
Andrew Chang ◽  
Brian Mac Grory ◽  
Mahesh Jayaraman ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals The Addition of Atrial Fibrillation to the Los Angeles Motor Scale May Improve Prediction of Large Vessel Occlusion

2019 ◽  
Author(s):  
Priya Narwal ◽  
Andrew D. Chang ◽  
Brian Mac Grory ◽  
Mahesh Jayaraman ◽  
Tracy Madsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals 285 Predictive Value of the Los Angeles Motor Scale for Large Vessel Occlusion Strokes

2018 ◽  
Vol 72 (4) ◽  
pp. S112-S113
Author(s):  
P. Banerjee ◽  
L. Ganti ◽  
J. Rosario ◽  
M. Wallen ◽  
L. Dub ◽  
...  
Keyword(s):  
Los Angeles ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

The Los Angeles Motor Scale as a predictor of angiographically determined large vessel occlusion

2020 ◽  
Vol 15 (4) ◽  
pp. 695-700
Author(s):  
Ethan Samuel Brandler ◽  
Henry Thode ◽  
David Fiorella
Keyword(s):  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

scholarly journals Los Angeles Motor Scale to Identify Large Vessel Occlusion

Stroke ◽  
2018 ◽  
Vol 49 (3) ◽  
pp. 565-572 ◽  
Author(s):  
Ali Reza Noorian ◽  
Nerses Sanossian ◽  
Kristina Shkirkova ◽  
David S. Liebeskind ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Los Angeles ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Los Angeles Motor Scale

Abstract TMP62: Utility of the Los Angeles Motor Scale to Identify Emergency Large Vessel Occlusion in Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Prasannna Tadi ◽  
Pranav Reddy ◽  
Sravanthi Pemmasani ◽  
Nasir Fakhri ◽  
Matthew Siket ◽  
...  
Keyword(s):  
Los Angeles ◽  
Positive Predictive Value ◽  
Acute Stroke ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Vessel Imaging ◽  
Los Angeles Motor Scale

Introduction: Stroke is a common medical emergency. The outcome depends upon access to stroke specialists, rapid scanning, assessment, and treatments. Identification of large vessel occlusion (LVO) is critical in the selection of patients for emergency embolectomy (clot removal) in patients with acute ischemic stroke. A pre-hospital stroke severity scale, such as the Los Angeles Motor Scale (LAMS) may have utility in selecting appropriate patients for CTA, while minimizing radiation exposure risk to the population as a whole. Methods: This was a retrospective analysis of 249 consecutive code stroke activations at a comprehensive stroke center during a 3.5 month period using a LAMS cutoff of ≥4 to trigger CTA acquisition. We determined the sensitivity, specificity, positive predictive value, and negative predictive value of using LAMS to detect large vessel occlusion (LVO). Gold standard was any vessel imaging within 24 hours. Inter-rater reliability of LAMS scoring was determined by blinded scoring of physical exam data from the chart by 3 neurovascular physicians. Results: There were 249 code stroke activations during the study period: 91 acute CTAs were recommended based on LAMS scoring. 20 large vessel occlusions were detected. 158 patients did not have a CTA acutely; none had a LVO during subsequent vessel imaging. The sensitivity is 100%, negative predictive value 100%, specificity 69%, positive predictive value 22% of the LAMS triage method. Inter-rater Reliability: Shrout-Fleiss pairwise weighted kappa coefficients between the three raters on LAMS scores were 0.67, 0.55, and 0.62. Kappa coefficients for pairs of raters when LAMS were dichotomized as <3 vs 4-5 were 0.64, 0.50, and 0.71. Clinically meaningful disagreements were evident. Conclusions: Accuracy and ease-of-use makes LAMS an ideal clinical tool to rapidly assess acute stroke patients for LVO and emergency mechanical thrombectomy. LAMS demonstrated excellent sensitivity in excluding patients who did not have a LVO. Appropriate training is required to ensure accuracy of LAMS scoring by providers.

scholarly journals Real-World Field Performance of the Los Angeles Motor Scale as a Large Vessel Occlusion Screen: A Prospective Muticentre Study

2021 ◽  
pp. 1-8
Author(s):  
Tej G. Stead ◽  
Paul Banerjee ◽  
Latha Ganti
Keyword(s):  
Los Angeles ◽  
Predictive Validity ◽  
Real World ◽  
Urban Areas ◽  
Large Vessel ◽  
Hospital Death ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Discharge Disposition ◽  
Los Angeles Motor Scale

<b><i>Background:</i></b> The Los Angeles Motor Scale (LAMS) is a 3-item, 0-to-5-point motor stroke-deficit scale derived from the Los Angeles Prehospital Stroke Screen. We assessed the predictive validity (for interventions performed and discharge disposition) of the LAMS performed in the field by paramedics in a geographic region of over 5,200 km<sup>2</sup>, covering both rural and urban areas. <b><i>Methods:</i></b> We analyzed data gathered from Phase I of the LIT-PASS study (Large Vessel Occlusion Identification Through Prehospital Administration of Stroke Scales) which included all patients with suspected acute cerebrovascular disease, as assessed by the Balance, Eyes, Face, Arm, Speech, Terrible Headache/Time to Call 911 (BE-FAST) test. <b><i>Results:</i></b> Among 1,906 patients with median age 72 years (interquartile range [IQR] 60–81), 53% were female with a median on-scene time of 15 min (IQR 12–19). C statistics for the interventions of mechanical thrombectomy, alteplase administration, computed tomography angiography, and perfusion imaging were 0.681, 0.643, and 0.680, respectively. The cut point for predicting these 3 interventions was confirmed to be LAMS ≥ 4. LAMS ≥ 4 had sensitivity 0.730 (0.661–0.790) and specificity 0.570 (0.539–0.601) for mechanical intervention (endovascular thrombectomy, coiling, or clipping) and relative risk of 2.98 (2.19–4.07) for in-hospital death. <b><i>Conclusions:</i></b> This real-world field study validates the LAMS as an effective tool for prehospital assessment of suspected strokes in determining transport decisions, with predictive validity for interventions performed.

First pass effect in patients with large vessel occlusion strokes undergoing neurothrombectomy: insights from the Trevo Retriever Registry

2021 ◽  
pp. neurintsurg-2020-016952
Author(s):  
Ashutosh P Jadhav ◽  
Shashvat M Desai ◽  
Ronald F Budzik ◽  
Rishi Gupta ◽  
Blaise Baxter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Basilar Artery Occlusion ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Single Pass ◽  
First Pass Effect ◽  
First Pass

BackgroundFirst pass effect (FPE), defined as near-total/total reperfusion of the territory (modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3) of the occluded artery after a single thrombectomy attempt (single pass), has been associated with superior safety and efficacy outcomes than in patients not experiencing FPE.ObjectiveTo characterize the clinical features, incidence, and predictors of FPE in the anterior and posterior circulation among patients enrolled in the Trevo Registry.MethodsData were analyzed from the Trevo Retriever Registry. Univariate and multivariable analyses were used to assess the relationship of patient (demographics, clinical, occlusion location, collateral grade, Alberta Stroke Program Early CT Score (ASPECTS)) and device/technique characteristics with FPE (mTICI 2c/3 after single pass).ResultsFPE was achieved in 27.8% (378/1358) of patients undergoing anterior large vessel occlusion (LVO) thrombectomy. Multivariable regression analysis identified American Society of Interventional and Therapeutic Neuroradiology (ASITN) levels 2–4, higher ASPECTS, and presence of atrial fibrillation as independent predictors of FPE in anterior LVO thrombectomy. Rates of modified Rankin Scale (mRS) score 0–2 at 90 days were higher (63.9% vs 53.5%, p<0.0006), and 90-day mortality (11.4% vs 12.8%, p=0.49) was comparable in the FPE group and non-FPE group. Rate of FPE was 23.8% (19/80) among basilar artery occlusion strokes, and outcomes were similar between FPE and non-FPE groups (mRS score 0–2, 47.4% vs 52.5%, p=0.70; mortality 26.3% vs 18.0%, p=0.43). Notably, there were no difference in outcomes in FPE versus non-FPE mTICI 2c/3 patients.ConclusionTwenty-eight percent of patients undergoing anterior LVO thrombectomy and 24% of patients undergoing basilar artery occlusion thrombectomy experience FPE. Independent predictors of FPE in anterior circulation LVO thrombectomy include higher ASITN levels, higher ASPECTS, and the presence of atrial fibrillation.

Effect of Known Atrial Fibrillation and Anticoagulation Status on the Prehospital Identification of Large Vessel Occlusion

2019 ◽  
Vol 28 (12) ◽  
pp. 104404 ◽  
Author(s):  
Parneet Grewal ◽  
Sourabh Lahoti ◽  
Sushanth Aroor ◽  
Kaitlin Snyder ◽  
Luther C. Pettigrew ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Effect of prior antiplatelet therapy on large vessel occlusion in patients with non-valvular atrial fibrillation newly initiated on apixaban

2021 ◽  
pp. 117603
Author(s):  
Kou Tokuda ◽  
Yoshitaka Yamada ◽  
Kazutaka Uchida ◽  
Fumihiro Sakakibara ◽  
Nobuyuki Sakai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiplatelet Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Large vessel occlusion is independently associated with atrial fibrillation detection

2020 ◽  
Vol 27 (8) ◽  
pp. 1618-1624 ◽  
Author(s):  
J. Pagola ◽  
J. Juega ◽  
J. Francisco‐Pascual ◽  
A. Bustamante ◽  
A. Penalba ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Atrial Fibrillation Detection
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