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Introduction: Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS., Patients and Methods: We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry. We assessed MRI small vessel disease (SVD) markers, SVD burden score, modified Rankin Scale (mRS) and ischaemic stroke or ICH at 3 months., Results: We included 716 patients, 117 patients (16.3%) with deep ICH (mean age (SD) 65.1 (±15.2) years, 37.1% female) and 599 patients (83.7%) with LS (mean age (SD) 69.7 (±13.6) years, 39.9% female). Compared to LS, deep ICH was associated with a higher SVD burden score (median (IQR) 2 (1-2) vs 1 (0-2)), aOR shift 3.19, 95%CI 2.15-4.75). Deep ICH patients had more often cerebral microbleeds (deep ICH: 71.6% vs LS: 29.2%, p  < 0.001, median count (IQR) 4(2-12) vs 2(1-6)) and a higher prevalence of lacunes (deep ICH: 60.5% vs LS: 27.4% p  < 0.001). At 3 months, deep ICH was associated with higher mRS (aOR shift 2.16, 95%CI 1.21-3.87). Occurrence of ischaemic stroke was numerically but not significantly higher in deep ICH (4.3% vs 2.9%; p  = 0.51). One patient (1.1%) with ICH but none with LS suffered ICH recurrence., Discussion/conclusion: DPA manifesting as ICH is associated with more severe MRI SVD burden and worse outcome compared to LS. The short-term risks of subsequent ischaemic stroke and recurrent ICH are similar in ICH and LS patients. This implies potential consequences for future secondary prevention strategies., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Goeldlin: Grants from Swiss Academy of Medical Sciences/Bangerter-Rhyner-Foundation, Mittelbauvereinigung der Universität Bern (outside the submitted work), Swiss Stroke Society (Förderpreis), European Stroke Organisation (department to department visit grant), Insel Gruppe, and Pfizer congress grant (outside the submitted work). Dr. Siepen: Funding by the Bangerter-Rhyner-Foundation (outside the submitted work). Dr. Fischer: research support from Swiss National Science Foundation, Swiss Heart Foundation, Medtronic (BEYOND SWIFT, SWIFT DIRECT), Stryker, Rapid medical, Penumbra, Phenox (DISTAL), consultancies for Medtronic, Stryker, and CSL Behring (fees paid to institution), participation in an advisory board for Alexion/Portola and Boehringer Ingelheim (fees paid to institution).Dr. Seiffge: Advisory board for Bayer and Portola/Alexion, Research grant from the Bangerter-Rhyner Foundation. All other authors do not report conflicts of interest.

Aims: We assessed the association of prior antiplatelet therapy (APT) at onset of intracerebral haemorrhage (ICH) with haematoma characteristics and outcome., Methods: We performed a systematic review and meta-analysis of studies comparing ICH outcomes of patients on APT (APT-ICH) with patients not taking APT (non-APT-ICH). Primary outcomes were haematoma volume (mean difference and 95% CI), haematoma expansion (HE), in-hospital 3-month mortality rates and good functional outcome (modified Rankin Scale score 0-2). We provide odds ratios (ORs) from random effects models and subgroup analyses for haematoma expansion and short-term mortality rates., Results: We included 23 of 1551 studies on 30,949 patients with APT-ICH and 62,018 with non-APT-ICH. Patients on APT were older (Δmean 6.27 years, 95% CI 5.44-7.10), had larger haematoma volume (Δmean 5.74 mL, 95% CI 1.93-9.54), higher short-term mortality rates (OR 1.44, 95% CI 1.14-1.82), 3-month mortality rates (OR 1.58, 95% CI 1.14-2.19) and lower probability of good functional outcome (OR 0.61, 95% CI 0.49-0.77). While there was no difference in HE in the overall analysis (OR 1.32, 95% CI 0.85-2.06), HE occurred more frequently when assessed within 24 h (OR 2.58, 95% CI 1.18-5.67). We found insufficient data for comparison of single versus dual APT-ICH. Heterogeneity was substantial amongst studies., Discussion: APT is associated with larger baseline haematoma volume, early (<24 h) haematoma expansion, mortality rates and morbidity in patients with ICH. Data on differences in single and dual APT-ICH are scarce and warrant further investigation. New treatment options for APT-ICH are urgently needed., Competing Interests: Declaration of conflicting interest: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MBG reports grants and awards from the Mittelbauvereinigung der Universität Bern and the Swiss Stroke Society (Förderpreis) as well as a congress grant from Pfizer, which are not related to the conduct of this study. BV reports personal fees from Pfizer AG/Bristol-Myers Squibb SA, personal fees from Bayer AG, grants from Institutional grant (Inselspital), personal fees from Ipsen Pharma, personal fees from CSL Behring, outside the submitted work. DJS was supported by research grants from the Swiss National Science Foundation, the Bangerter-Rhyner Foundation, the Swiss Society of Neurology and the 2017 Bayer Foundation Thrombosis Award. B. Siepen, M. Mueller, W. Z’Graggen, D. Bervini, A. Raabe, N. Sprigg and U. Fischer have nothing to disclose., (© European Stroke Organisation 2021.)