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Small-vessel disease in the brain.

Amita Singh1, Gabriel Bonnell1, Justin De Prey1

  • 1Department of Neurology, University of Florida, Gainesville, FL, United States of America.

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Summary

Cerebral small-vessel disease (CSVD) affects brain vessels and can cause stroke or dementia. While aspirin isn't proven for primary prevention, it remains key for secondary stroke prevention in specific cases.

Keywords:
BrainHemorrhageIschemic strokeSmall-vessel diseaseVascular dementia

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Area of Science:

  • Neurology
  • Vascular Medicine
  • Cerebrovascular Disease

Background:

  • Cerebral small vessels perfuse critical subcortical brain structures.
  • Cerebral small-vessel disease (CSVD) manifests as lacunar stroke, hemorrhage, and vascular dementia.
  • CSVD shares risk factors with cardiovascular disease, including hypertension, diabetes, and hypercholesterolemia, alongside genetic factors.

Purpose of the Study:

  • To review the role of aspirin in primary and secondary prevention strategies for CSVD.
  • To highlight the clinical manifestations and risk factors associated with CSVD.

Main Methods:

  • Literature review focusing on CSVD, its risk factors, clinical outcomes, and prevention strategies.
  • Analysis of current evidence regarding antiplatelet therapy, specifically aspirin, in CSVD management.

Main Results:

  • Aspirin is not established as a primary prevention strategy for CSVD in the general population.
  • Long-term aspirin therapy is the standard for secondary stroke prevention in non-cardioembolic ischemic stroke and high-risk transient ischemic attack (TIA).

Conclusions:

  • CSVD management requires addressing modifiable vascular risk factors.
  • Aspirin plays a crucial role in secondary prevention for specific cerebrovascular events related to small vessel disease.