National University of Malaysia, UKM Medical Centre
Department of Medicine
I’m a consultant neurologist and senior lecturer at the National University of Malaysia Medical Centre, a comprehensive stroke centre in Kuala Lumpur, Malaysia. My main research focus is on intracerebral haemorrhage. I completed a PhD in stroke medicine at the University of Nottingham, United Kingdom, working on data from the Tranexamic acid in IntraCerebral Haemorrhage-2 (TICH-2) randomised controlled trial. I was the national coordinator the TICH-2 for Malaysia and was also involved as an investigator/ trial physician for several stroke randomised controlled clinical trials, including RIGHT-2, RESTART, RESTORE brain, LACI-1, ATTEST-2, TASTE and TWIST. I look forward to international research/academic collaborations and am eager to be involved in more clinical trials in stroke. To date, I have 50+ journal publications including in the Lancet, Stroke, International Journal of Stroke, European Stroke Journal and Cochrane Systematic Reviews. I’m also a reviewer for several stroke/neurology journals. My research profiles and links are follows: https://scholar.google.co.uk/citations?user=8pTNoKAAAAAJ&hl=en https://www.researchgate.net/profile/Zhe_Kang_Law2 My email: zhe.kanglaw@ppukm.ukm.edu.my

Presenter of 1 Presentation

EFFECTS OF RATIO OF HAEMATOMA VOLUME TO INTRACRANIAL VOLUME ON HAEMATOMA GROWTH AND MASS EFFECT: POST-HOC ANALYSIS OF RIGHT-2 TRIAL

Session Type
Oral Presentations
Date
27.10.2021, Wednesday
Session Time
09:00 - 09:20
Room
ORAL PRESENTATIONS 2
Lecture Time
09:00 - 09:10

Abstract

Background and Aims

The risk of haematoma expansion in intracerebral haemorrhage (ICH) increases with larger baseline volume until haemostasis or a tamponade is effected by the rigid cranium. We explored the association of ICH volume to intracranial volume ratio (ICH/ICV) with mass effect and whether it could predict haematoma expansion at 24-hour.

Methods

CT scans of 133 patients with ICH in the RIGHT-2 trial were analysed. ICH/ICV ratio (%) was estimated using semi-automated segmentation methods. Significant mass effect was defined as midline shift of ≥5mm or ambient cistern score of ≥1 (effacement of at least one ambient cistern). Multivariable logistic regression with adjustment for baseline variables was performed to explore the predictors of haematoma expansion (>6mL or >33%) and significant mass effect.

Results

fig1.pngfig2.png

The mean baseline ICH volume was 37.8 (38.6) mL and mean ICH/ICV ratio 2.68 (2.72)%. ICH/ICV ratio of ≥6% was significantly associated with ambient cistern effacement (adjusted odd ratio [aOR] 21.6, 95%CI 5.5-84.8) and midline shift ≥5mm (aOR 220) on baseline CT but not at lower cut-offs. Increasing ICH/ICV ratio predicted haematoma expansion but the effect plateaued at 3-4% when further increase did not significantly increase the aOR (Figure 1). The accuracy of ICH/ICV ratio in predicting haematoma expansion was similar compared to ICH volume (area under the receiver operator characteristics curve 0.69 for both, Figure 2).

Conclusions

ICH/ICV ratio predicted haematoma expansion and may be used to prognosticate or stratify patients in stroke trials testing potential treatments. The potential mechanisms and effect on functional outcomes need further exploration.

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