Doctors have traditionally treated many strokes by targeting fatty plaque inside larger arteries.
However, growing evidence suggests that this approach may not address the underlying problem in one of the most common forms of stroke. A new study points instead to damage affecting the brain’s tiniest blood vessels.
The research, published in Circulation by scientists from the University of Edinburgh and collaborating institutions, focused on lacunar ischemic stroke. This type of stroke occurs deep within the brain and is strongly linked with cerebral small vessel disease, a condition that also increases the risk of cognitive decline and dementia.
The researchers examined 229 patients who had experienced either a lacunar stroke or another mild stroke. Brain MRI scans performed shortly after the stroke and again one year later allowed the team to compare different patterns of blood vessel damage and identify new brain injuries.
One possibility was that fatty plaque narrowing larger arteries was responsible. Another was that widening and elongation of arteries reflected disease affecting the brain’s delicate blood vessel network. The study found much stronger evidence supporting the second explanation.
Patients with enlarged arteries were more than four times as likely to have suffered a lacunar stroke. They also showed more severe small vessel disease, faster progression of brain damage and a greater risk of developing silent strokes during follow-up.
Silent strokes often go unnoticed because they may not produce obvious symptoms. Even so, repeated silent injuries can gradually affect memory, thinking, balance and independence. Preventing these hidden brain injuries is therefore an important goal of treatment.
The findings may explain why aspirin and similar antiplatelet medicines have not been especially effective for preventing lacunar stroke. If the main problem lies within damaged small blood vessels instead of blocked large arteries, different treatment strategies may be required.
Researchers are now testing medicines such as cilostazol and isosorbide mononitrate in the LACI-3 clinical trial. These drugs are designed to protect the brain’s microcirculation and may eventually reduce the risks of future stroke, dementia and disability.
The study highlights how advances in brain imaging are changing scientists’ understanding of stroke. By identifying the true biological cause of disease, researchers can design treatments that more directly target the underlying problem.
This well-conducted imaging study provides convincing evidence that small vessel disease, rather than fatty plaque in larger arteries, is central to lacunar stroke.
Although the results are promising, they do not yet prove that new medicines will improve patient outcomes. Ongoing clinical trials will be essential to determine whether treatments aimed at protecting the brain’s smallest blood vessels can successfully prevent future strokes.
If you care about stroke, please read studies that diets high in flavonoids could help reduce stroke risk, and MIND diet could slow down cognitive decline after stroke.
For more health information, please see recent studies about antioxidants that could help reduce the risk of dementia, and tea and coffee may help lower your risk of stroke, dementia.
Source: University of Edinburgh.
