ESOC 2019 Session Report: Cerebral Small Vessel Disease: an Update
By: Dr Kailash Krishnan, MRCP (UK), MRCP (Lond), PhD, FESO
Dr Ostergaard started off this much anticipated session here at the European Stroke Organisation Conference in Milan by explaining capillary haemodynamics in normal state, ageing and small vessel diseases including ischaemic stroke (IS) and Alzheimer’s dementia (AD). He went onto demonstrate how dysfunction of haemodynamics affects cognitive performance in patients with mild cognitive impairment (MCI) and AD. He also showed how CAA interferes with microvascular flow distributions in MCI and blood properties (including Hb levels, viscosity, leucocytosis) matter. Techniques to measure microvessels are currently inadequate and more research into this area is ongoing.
Diagnostic algorithms in CAA was the next lecture and the co-morbidity of cerebral vessel disease in lobar and non-lobar haemorrhages was highlighted by Dr R Al-Shahi Salman. He went onto show a simple diagnostic prediction model based on clinical and pathological features (APOE e4 positive, any SAH, finger-like projections) rule in or rule out CAA. This is definitely promising but needs validation in future studies. The MRI (Boston) criteria for lobar CAA-ICH was also discussed and Dr Al-Shahi Salman discussed the sensitivity (95%) and sensitivity (>80%). More work into further refinement of this score is underway and the results are awaited.
The role of pericytes as a contractile apparatus and regulation of blood-brain permeability in normal health and how restriction of capillary perfusion and opening of BBB occurs in ischaemic stroke, AD and CADASIL using pre-clinical models was highlighted by Dr Plesnila in the third lecture. This coupled with the next session examining the dynamics of SVD on MRI both-short term (acute ischaemic stroke) and long-term (including progression and regression and link between different lesion types) made the session very interesting.
Treatment of small vessel disease including diagnosis, balancing benefit/risk (haemorrhage versus ischaemia) profiles and future work concluded a comprehensive overview of a session for both clinicians and researchers.