Improving Candidate Selection for Endovascular Thrombectomy
Incorporating acute ischemic stroke due to large vessel occlusion (LVO) screening using the Los Angeles Motor Scale (LAMS) is feasible and reduces time to computed tomography angiography (CTA) and time to endovascular thrombectomy (EVT).
Evidence Rating Level: 2 (Good)
Timely EVT for acute ischemic stroke caused by LVO is critical for patient outcomes. However, current Code Stroke protocols are not designed to identify patients with LVO, potentially delaying gold standard therapy.
Code LVO Implementation
Conventional Code Stroke protocols recommend noncontrast CT head as initial imaging to rule out intracranial hemorrhage. However, the preferred imaging modality for LVO ischemic stroke is CTA with or without CT perfusion (CTP).
- Patient triage for LVO using LAMS
- Patient with LAMS ≥ 4: immediate CTA/CTP and early EVT team notification
- Patient with LAMS < 4: managed with conventional code stroke pathway
Code stroke of large vessel occlusion at triage improves candidate selection and workflow efficiency of endovascular thrombectomy.
Author's summary: Code LVO improves patient outcomes by streamlining the EVT process.
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