Wang Richard, Lakhani Dhairya A, Balar Aneri B, Sepehri Sadra, Hyson Nathan, Luna Licia P, Cho Andrew, Hillis Argye E, Koneru Manisha, Hoseinyazdi Meisam, Lu Hanzhang, Mei Janet, Xu Risheng, Nabi Mehreen, Mazumdar Ishan, Urrutia Victor C, Chen Kevin, Huang Judy, Nael Kambiz, Yedavalli Vivek S
Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Interv Neuroradiol. 2024 Oct 1:15910199241282434. doi: 10.1177/15910199241282434.
Mechanical thrombectomy (MT) is the treatment standard in eligible patients with acute ischemic stroke (AIS) secondary to large vessel occlusions (LVO). Studies have shown that good collateral status is a strong predictor of MT efficacy, thus making collateral status important to quickly assess. The Los Angeles Motor Scale is a clinically validated tool for identifying LVO in the field. The aim of this study is to investigate whether admission LAMS score is also associated with the American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score on digital subtraction angiography (DSA).
We conducted a retrospective multicenter cohort study of consecutive patients presenting with AIS caused by LVO from 9/1/2017 to 10/1/2023 with diagnostically adequate DSA imaging. Demographic, clinical, and imaging data was collected through manual chart review. Both univariate and multivariate analysis were applied to assess associations. A -value <0.05 was considered significant.
A total of 308 patients (median age: 68, IQR: 57.5-77) were included in the study. On multivariate logistic regression analysis, we found that lower admission LAMS score (adjusted OR: 0.82, 95% CI: 0.68-0.98, < 0.05) and higher ASPECTS score (adjusted OR: 1.21, 95% CI: 1.02-1.42, < 0.05) were independently associated with good DSA ASITN collateral score of 3-4.
Admission LAMS and ASPECTS score are both independently associated with DSA ASITN collateral score. This demonstrates the capability of LAMS to act as a surrogate marker of CS in the field.
机械取栓术（MT）是符合条件的急性缺血性卒中（AIS）继发于大血管闭塞（LVO）患者的治疗标准。研究表明，良好的侧支循环状态是MT疗效的有力预测指标，因此快速评估侧支循环状态很重要。洛杉矶运动量表是一种经临床验证的用于在现场识别LVO的工具。本研究的目的是调查入院时的洛杉矶运动量表（LAMS）评分是否也与数字减影血管造影（DSA）上的美国介入和治疗神经放射学会（ASITN）侧支循环评分相关。
我们对2017年9月1日至2023年10月1日因LVO导致AIS且有诊断性充分DSA成像的连续患者进行了一项回顾性多中心队列研究。通过人工查阅病历收集人口统计学、临床和影像学数据。采用单变量和多变量分析来评估相关性。P值<0.05被认为具有统计学意义。
本研究共纳入308例患者（中位年龄：68岁，四分位间距：57.5 - 77岁）。在多变量逻辑回归分析中，我们发现较低的入院LAMS评分（调整后的比值比：0.82，95%置信区间：0.68 - 0.98，P<0.05）和较高的脑梗死溶栓治疗前脑CT评分（ASPECTS评分）（调整后的比值比：1.21，95%置信区间：1.02 - 1.42，P<0.05）与良好的DSA ASITN侧支循环评分为3 - 4分独立相关。
入院时的LAMS评分和ASPECTS评分均与DSA ASITN侧支循环评分独立相关。这表明LAMS在现场可作为侧支循环状态的替代标志物。
