Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis

OBJECTIVE: Cerebral small vessel disease (CSVD) describes a syndrome of neuroimaging, pathological, and associated clinical features caused by small intracranial vascular lesions, which commonly coexists with large artery atherosclerosis (LAA) and has been identified as a major cause of motor impairment over time. In this review, we aim to summarize the relationship between CSVD and LAA, and discuss the effects of CSVD on the clinical outcome of patients with ischemic stroke caused by LAA. METHODS: We searched and scanned all the literature with the keyword cerebral small vessel disease, cerebral microbleeds, white matter hyperintensity, silent lacunar infarcts, enlarged perivascular spaces and stroke in the database of Pubmed and MEDLINE (from inception to 1 February 2015). RESULTS: Various imaging phenotypes of CSVDs have different influences on the clinical outcome of patients with LAA stroke. The total brain burden of CSVD can represent the cumulative effects of different MRI features of CSVD, which has predictive value for recurrent stroke after ischemic stroke. Better quantification of the total brain burden of CSVD may help stratify patients more effectively in clinical practice. DISCUSSION: CSVD can significantly influence the clinical outcome of stroke in patients with cerebral infarction caused by LAA, and the methods to capture whole brain CSVD burden cross the spectrum of changes in CSVD imaging features may be useful for patient stratification in clinical trials. Further studies should be performed to validate the relationship between CSVD related brain damage and LAA stroke.