Youtube spam comments tend to have highly atypical patterns, using things like unicode characters to avoid triggering keyword and URL filters. Something along the lines of GPT should pick up on these things pretty easily, and could similarly pick up on the actions these comments are requesting of users "message me on telegram", etc. It could also probably detect when spammers are trying to impersonate youtubers.
It's not really the kind of thing that spammers can use LLMs themselves to work around, either. Any attempt to get past the anti-spam LLM is going to look quite unusual compared to the typical comment which would tip it off.
Strangely Google seems reticent to try something in this vein though…