Advancing our knowledge about cerebral small vessel diseases

A structurally and functionally intact cerebral small vessel system that is responsive to the fluctuating demands of neurons, glia, and other associated cells is essential for brain health, providing the final common pathway that nourishes and protects the brain. Within this network are about 400 miles of capillaries, the primary site of oxygen and nutrient exchange, and an overarching system of blood vessels and related structures called the neurovasculome. 1 Cipolla MJ The cerebral circulation. in: integrated systems physiology: from molecule to function. 1st edn. Morgan & Claypool Life Sciences Publishers, Kentfield, CA2009: 1-59 Crossref Google Scholar , 2 Iadecola C Smith EE Anrather J et al. The neurovasculome: key roles in brain health and cognitive impairment: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2023; 54: e251-e271 Crossref PubMed Scopus (15) Google Scholar The neurovasculome is composed of all the extracranial, intracranial, and meningeal vessels, and the lymphatics and associated cells that subserve vital homoeostatic functions of the brain. 2 Iadecola C Smith EE Anrather J et al. The neurovasculome: key roles in brain health and cognitive impairment: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2023; 54: e251-e271 Crossref PubMed Scopus (15) Google Scholar The neurovasculome not only delivers the vital blood flow but also regulates immune trafficking and clears waste from the brain. Effect of blood pressure-lowering agents on microvascular function in people with small vessel diseases (TREAT-SVDs): a multicentre, open-label, randomised, crossover trial4 weeks of treatment with amlodipine, losartan, or atenolol did not differ in their effects on cerebrovascular reactivity in people with sporadic small vessel disease but did result in differential treatment effects in patients with CADASIL. Whether antihypertensive drug classes differentially affect clinical outcomes in people with small vessel diseases requires further research. Full-Text PDF