Ventura ELVO Score

What is the Ventura ELVO Score?

During a stroke, when the brain is not receiving adequate oxygen and nutrient supply, every second counts.

Almost 800,000 people have a stroke in the United States each year, and roughly 140,000 people die from a stroke (CDC 2017). Most of these are a result of ischemia, where a blockage stops blood flow to the brain (Benjamin et al 2019). The consequences of a stroke can be reduced when the process is quickly identified by emergency medical personnel, and the patient receives a timely intervention. In order to facilitate the recognition and appropriate treatment of a stroke, doctors and research scientists have worked to develop scales that use a short set of measures to give patients a “score” that can help them assess what is happening in the patient and develop a treatment plan.  The Ventura ELVO Score (VES), which measures the likelihood of an emergent large vessel occlusion (blockage of a coronary artery), is one such scale, and it has been used with great success to enhance outcomes in stroke patients.

Dr. M. Asif Taqi is a leading stroke specialist in Southern California who has contributed to the development and implementation of the Ventura ELVO Score. As a triple-board certified neurointerventionalist and researcher, he has extensive training and advanced expertise in treating strokes. His contributions to the use of ELVO scores in suspected ischemic stroke patients have led to enhanced implementation and lives saved. In fact, Dr. Taqi was instrumental in its testing and application, having published research on the subject. In addition to his superior technical skills, he is compassionate and caring. These combined traits have earned him a spot among California’s top doctors He was given 40 under 40 award by Canejo Valley for his contributions to this community. Contact us today to arrange your consultation in Thousand Oaks or West Hills.

Why is the Ventura ELVO scale necessary?

The Ventura ELVO scale is used by emergency medical services in the field to assess the likelihood of a large vessel occlusion that is causing an ischemic stroke. By examining four simple criteria, we can give the patient a quick score that helps to determine what happens next.  If the score suggests that the patient is likely having an ischemic stroke due to large vessel occlusion, we can route the patient to a stroke center, and the neurointerventionist team can be “triggered” while the patient is still in the field. 

graphic of brain

When triggered, the team will begin preparing for a procedure that will allow them to re-canalize the blocked blood vessel. This preparation, carried out while the patient is en route to the hospital, can cut minutes off the total time that it takes for the patient to be treated and helps to establish blood flow back to the brain more quickly. Because of the extensive damage that can occur to the brain tissue during an ischemic stroke, these critical minutes can make the difference between life and death and prevent lasting damage to the brain. The ELVO score has been tested and validated as an effective approach that improves patient outcomes (Taqi et al., 2019Suzuki et al., 2018).

What criteria are included in the Ventura ELVO score?

The Ventura ELVO score was developed to allow for rapid, straightforward detection of an emergent large vessel occlusion (ELVO). When a patient is suspected of having an ischemic stroke due to a blockage in one of the major vessels to the brain, the emergency response team (such as the paramedics) will assess the following criteria to give the patient an ELVO score.

Eye deviation is the drifting of the pupils towards one side of the head. For a patient to have a positive eye deviation, both eyes must be shifted towards the side.

To assess for aphasia, the emergency medical personnel will ask the patient to name an object or repeat a phrase or sentence. Patients that test positive for aphasia are awake but unable to do one of the following:

  • Name a common object
  • Repeat a sentence
  • Follow simple commands
  • Speak or repeat a phrase

Patients who are speaking gibberish also receive a positive aphasia score.

This criterion refers to the brain’s ability to notice or pay attention to something that is occurring on one side of the body. For instance, a patient may feel a stimulus on one side of the body but not the other. Or, he or she may be able to pay attention to someone who is standing to one side of them but then unable if the person moves to the other side.

Patients who are unable to stay awake during a conversation with EMS are considered obtunded and given a positive score for this criterion.

Each of the criteria is scored as positive or negative, and the patient receives one point for each positive test. The VES system is used for screening patients so that they can receive more timely treatment for their blood vessel occlusion. Patients who score a one or higher on the VES trigger the neuro-intervention team activation, improving their time-to-treatment substantially.

What causes large vessel occlusion?

Even though the brain requires large amounts of oxygen and nutrients to function properly, blood flows to it through a surprisingly small number of arteries. These major blood vessels to the brain have a crucial job, and blockages in these vessels can have devastating consequences. The large vessels to the brain include the carotid arteries and the cerebral arteries.

Diseases such as atherosclerosis and diabetes can contribute to the buildup of plaque on the walls of the blood vessels. Plaque can reduce and sometimes even block the flow of blood downstream.  Also, blood clots or debris from atherosclerotic plaques can lodge suddenly in a major vessel, preventing blood from reaching the brain tissue downstream of the vessel.  Additionally, a blood clot from the heart can travel up to the brain and causes a blockage.  This is one of the most common reason for an ischemic stroke.

 Dr. M. Asif Taqi is one of California’s leading stroke specialists. If you want to learn more about how Dr. Taqi uses the Ventura ELVO score to help his patients, Contact us or call 805.242.4884 to schedule your appointment today.