Prevention and Management of Cerebral Small Vessel Disease.
10.5853/jos.2015.17.2.111
- Author:
Vincent MOK
1
;
Jong S KIM
Author Information
1. Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
- Publication Type:Review
- Keywords:
Prevention;
Treatment;
Small vessel disease
- MeSH:
Antihypertensive Agents;
Aspirin;
Blood Pressure;
Brain;
Cerebral Hemorrhage;
Cerebral Small Vessel Diseases*;
Cholesterol;
Hemorrhage;
Humans;
Hydroxymethylglutaryl-CoA Reductase Inhibitors;
Hypertension;
Risk Factors;
Secondary Prevention;
Stroke;
Stroke, Lacunar
- From:Journal of Stroke
2015;17(2):111-122
- CountryRepublic of Korea
- Language:English
-
Abstract:
Lacunar infarcts/lacunes, white matter hyperintensities (WMH), and cerebral microbleeds (CMBs) are considered various manifestations of cerebral small vessel disease (SVD). Since the exact mechanisms of these manifestations differ, their associated risk factors differ. High blood pressure is the most consistent risk factor for all of these manifestations. However, a "J curve" phenomenon in terms of blood pressure probably exists for WMH. The association between cholesterol levels and lacunar infarcts/lacunes or WMH was less consistent and sometimes conflicting; a low cholesterol level probably increases the risk of CMBs. Homocysteinemia appears to be associated with WMH. It is noteworthy that the risk factors profile may also differ between different lacunar patterns and CMBs located at different parts of the brain. Thrombolysis, antihypertensives, and statins are used to treat patients with symptomatic lacunar infarction, just as in those with other stroke subtypes. However, it should be remembered that bleeding risks increase in patients with extensive WMH and CMBs after thrombolysis therapy. According to the Secondary Prevention of Small Subcortical Strokes trial results, a blood pressure reduction to <130 mmHg is recommended in patients with symptomatic lacunar infarction. However, an excessive blood pressure decrease may induce cognitive decline in older patients with extensive WMH. Dual antiplatelet therapy (aspirin plus clopidogrel) should be avoided because of the excessive risk of intracerebral hemorrhage. Although no particular antiplatelet is recommended, drugs such as cilostazol or triflusal may have advantages for patients with SVD since they are associated with less frequent bleeding complications than aspirin.
