This scientific session on cerebral small vessel disease was fascinating, well served by 5 excellent speakers. First, Pr Frank-Erik De Leeuw, from Nijmegen in the Netherlands, illustrated how dynamic can be the progression of cSVD. He demonstrated that the disease progression is far from being linear and that in some cases, clear regression of cSVD MRI markers can be demonstrated. In addition, in the INTENSE study he described how monthly DWI MRI showed in SVD patients has shown frequent asymptomatic “lacunes” which probably contribute to the burden of cSVD, confirming very preliminary data in 5 patients a few years ago. He explained how this potential paradigm shift may lead to new opportunities for therapeutic interventions.
Susanne van Veluw (from Boston, USA) updated us on the emerging field of cortical microinfarcts. While first considered tightly associated with cSVD, these lesions are in fact observed in various settings, some of which may not involve small vessels at all. She illustrated with data originating from animal studies how these tiny lesions may have structural consequences far beyond their core, possibly explaining the links observed between the presence of cortical microinfarcts and cognitive decline in several cohorts.
The third talk was given by Pr Joanna Wardlaw (Edinburgh, UK) who detailed the natural history of dilated perivascular spaces and their passive and active relationships with physiological aspects such as sleep and with pathology including hypertension. She reported data obtained in animal models which might help better understand the links between perivascular space and the pathology of cSDV.
The transition was natural with the talk of Pr Costantino Iadecola (Cornell University, USA) who described the role of perivascular and meningeal macrophages (PVM) as key players in vascular alterations and blood-brain barrier damage. He highlighted results in animal models suggesting that PVM may well mediate some of the most devastating effects of hypertension and cerebral amyloid angiopathy on small vessels.
The session ended up with the talk of Pr David Werring (London, UK) who reminded us with the clinical and radiological spectrum of cerebral amyloid angiopathy (CAA) before making a quick tour of the available evidence from both observational studies and trials driving care of CAA patients. He then detailed several aspects of his personal approach.