An interview with Dr. Marco Pasi, MD, Stroke Clinical Fellow at Université de Lille, CHU Lille, Inserm U1172, France, on his article “Clinical Relevance of Cerebral Small Vessel Diseases.” The article, co-authored by Prof. Charlotte Cordonnier, was published in the January 2020 issue of Stroke as part of a Focused Updates in Cerebrovascular Disease series of articles on topics related to cerebral small vessel diseases.
Interviewed by Dr. Parneet Grewal, MD, Vascular Neurology Fellow at Rush University Medical Center, Chicago, Illinois.
Dr. Grewal: First, I would like to thank Dr. Pasi and Pr. Cordonnier for agreeing to do this interview. This is an interesting paper which discusses in detail the main manifestations of cerebral small vessel disease (SVD) along with their impact. Can you please summarize the key findings of your paper and their application to clinical practice?
Dr. Pasi: Cerebral small vessel diseases (SVD) have gained increased interest in the last decades as they play a crucial role in a large variety of conditions, such as aging, stroke, cognitive impairment, and other age-related disabilities. The term SVDis used with various meanings according to the context, but from a neuropathological perspective, SVD describes a group of pathologies that affect the perforating arteries and arterioles located in the brain parenchyma or in the leptomeningeal vessels. Sporadic SVD is characterized by two main forms that mainly differ for their localization within the brain. The first one is arteriolosclerosis, also known as hypertensive-SVD, which has a predilection for the deep lenticulostriate arteries that are vulnerable to poorly controlled and long-standing hypertension or diabetes. The second most common form is cerebral amyloid angiopathy that is a pathological process characterized by the progressive accumulation of ß-amyloid protein in the wall of small cortical and leptomeningeal arterioles and arteries. It is clinically relevant to distinguish these two forms of SVD because they differ in terms of hemorrhagic risk with important consequences when antithrombotic decisions need to be taken. In our review, we aimed to provide a comprehensive overview of the main clinical manifestations of SVD that could help stroke physicians in their daily practice.