New Treatment Approaches to Modify the Course of Cerebral Small Vessel Diseases

Eric E. Smith, MD, MPH; Hugh S. Markus, FMedSci


Stroke. 2020;51(1):38-46. 

In This Article

Abstract and Introduction


Cerebral small vessel diseases (cSVDs) are a common cause of stroke and an important contributor to age-related cognitive decline and risk for dementia. Yet there is surprisingly little information on how to prevent their progression.

The common pathologies underlying cSVDs are arteriolosclerosis caused by aging, hypertension, and other conventional vascular risk factors and cerebral amyloid angiopathy (CAA) caused by vascular deposition of β-amyloid. These diseases lead to varied and overlapping types of vascular brain injury such as lacunes, white matter hyperintensities (WMHs) of presumed vascular origin, and microbleeds. These radiological manifestations of cSVD are common in aging populations. For example, >20% of elderly >80 years of age have ≥1 lacunes. Thus, cSVD is a major public health problem.

In this review, we discuss current treatment, identify gaps in our knowledge, review current trials addressing these gaps, and highlight methodological considerations that are important in planning future trials in cSVD.