RT Journal Article SR Electronic T1 Diffusion-weighted imaging lesions and risk of recurrent stroke after intracerebral haemorrhage JF Journal of Neurology, Neurosurgery & Psychiatry JO J Neurol Neurosurg Psychiatry FD BMJ Publishing Group Ltd SP jnnp-2021-326116 DO 10.1136/jnnp-2021-326116 A1 Kim Wiegertjes A1 Lynn Dinsmore A1 Jonathan Drever A1 Aidan Hutchison A1 Jacqueline Stephen A1 Maria C Valdés Hernández A1 Priya Bhatnagar A1 David P Minks A1 Mark A Rodrigues A1 David J Werring A1 Frank-Erik de Leeuw A1 Catharina JM Klijn A1 Rustam Al-Shahi Salman A1 Phillip M White A1 Joanna M Wardlaw YR 2021 UL http://jnnp.bmj.com/content/early/2021/06/08/jnnp-2021-326116.abstract AB Objective To determine whether the presence of diffusion-weighted imaging-positive (DWI+) lesions is associated with recurrent stroke after intracerebral haemorrhage (ICH).Methods The REstart or STop Antithrombotics Randomised Trial (RESTART) assessed the effect of restarting versus avoiding antiplatelet therapy after ICH on major vascular events for up to 5 years. We rated DWI sequences of MRI done before randomisation for DWI+ lesion presence, masked to outcome and antiplatelet use. Cox proportional hazards regression models were used to quantify associations.Results Of 537 participants in RESTART, 247 (median (IQR) age 75.7 (69.6–81.1) years; 170 men (68.8%); 120 started vs 127 avoided antiplatelet therapy) had DWI sequences on brain MRI at a median of 57 days (IQR 19–103) after ICH, of whom 73 (30%) had one or more DWI+ lesion. During a median follow-up of 2 years (1–3), 18 participants had recurrent ICH and 21 had ischaemic stroke. DWI+ lesion presence was associated with all stroke, (adjusted HR 2.2 (95% CI 1.1 to 4.2)) and recurrent ICH (4.8 (95% CI 1.8 to 13.2)), but not ischaemic stroke (0.9 (95% CI 0.3 to 2.5)). DWI+ lesion presence (0.5 (95% CI 0.2 to 1.3)) vs absence (0.6 (95% CI 0.3 to 1.5), pinteraction=0.66) did not modify the effect of antiplatelet therapy on a composite outcome of recurrent stroke.Conclusions DWI+ lesion presence in ICH survivors is associated with recurrent ICH, but not with ischaemic stroke. We found no evidence of modification of effects of antiplatelet therapy on recurrent stroke after ICH by DWI+ lesion presence. These findings provide a new perspective on the significance of DWI+ lesions, which may be markers of microvascular mechanisms associated with recurrent ICH.Trial registration number ISRCTN71907627.Data are available upon reasonable request. An anonymised version of the RESTART data set will be available from 22 May 2020 (1 year after publication of the primary findings), upon request to the members of the RESTART trial steering committee by using the online data request form (https://www.research.ed.ac.uk/portal/en/datasets/restart-data-request-form(54c98845-fdbc-45ea-a5fc-495df837ad25).html).