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Advanced Neurology Covert cerebral small vessel disease

trials in CSVD with consistent trial methodologies to Funding
facilitate the interpretation of findings. 46
None.
Recently, the LACI-2 group shared insights from
the LACI-1 and LACI-2 trials that are important for Conflict of interest
improving future clinical trial designs in CSVD. Their The authors declare they have no competing interests.
analyses highlighted important considerations such as
sample size, broad entry criteria, imaging and clinical Author contributions
outcomes, remote assessment methods, handling missing
data, adherence issues, and statistical analysis techniques. Conceptualization: Alina González-Quevedo, Tania Arrieta
These insights could assist the scientific community in Hernández
identifying effective treatments to improve CSVD clinical Writing – original draft: All authors
outcomes. 47 Writing – review & editing: All authors
5. Concluding remarks Ethics approval and consent to participate

Considering the significant evidence regarding the severe Not applicable.
consequences of CSVD on brain vascular health, there is a
consensus among vascular neurologists about the urgent Consent for publication
need to develop therapeutic strategies aimed at delaying
this process. Not applicable.
Figure 2 displays a schematic representation of Availability of data
the suggested framework for detecting and managing Not applicable.
covert CSVD. The first step involved screening
asymptomatic vulnerable populations with vascular risk References
factors employing non-imaging biomarkers to identify
individuals at higher risk for a more severe burden of 1. Meinel TR, Wardlaw JM, Kent DM. Is incidentally
CSVD. These individuals could then be referred for brain discovered covert cerebrovascular disease ignorable? JAMA
Neurol. 2024;81(5):437-438.
MRI. An interesting suggestion is the implementation
of high-risk multidisciplinary CSVD clinics tailored doi: 10.1001/jamaneurol.2023.5456
to the specific conditions and resources available in 2. Gao Y, Li D, Lin J, et al. Cerebral small vessel disease:
5
different healthcare settings. Subsequently, healthcare Pathological mechanisms and potential therapeutic targets.

professionals at the primary level or within these Front Aging Neurosci. 2022;14:961661.
multidisciplinary clinics would develop personalized doi: 10.3389/fnagi.2022.961661
strategies for treating and systematically monitoring
individuals with a more severe burden of CSVD, in 3. Lam BYK, Cai Y, Akinyemi R, et al. The global burden of
cerebral small vessel disease in low- and middle-income
accordance with existing guidelines. It is essential to countries: A systematic review and meta-analysis. Int J
highlight that the results from population screening Stroke. 2023;18:15-27.
strategies can also help form clinical cohorts of patients
with incidentally discovered CSVD, facilitating the doi: 10.1177/17474930221137019
organization of future clinical trials. 4. González-Quevedo A, González-García S, Peña-Sánchez M,
Menéndez-Sainz C, Fernández-Carriera R, Codero Eiriz A.
One of the most important features in the future of Blood-based biomarkers could help identify subclinical
CSVD management is the development of treatment brain damage caused by arterial hypertension. MEDICC
strategies focused on targeting the specific pathogenic Rev. 2016;18(1-2):46-53.
mechanisms underlying disease progression. Hence,
further research into these mechanisms is needed, doi: 10.37757/MR2016.V18.N1-2.9
alongside efforts to repurpose existing drugs, develop new 5. Hannawi Y, Vaishnav A, Coskun EP, Gangadhara S, Romero JR.
molecular candidates, and design sufficiently powered, Covert cerebral small vessel disease: Ready for clinical prime
high-quality randomized clinical trials focused on CSVD. time. J Am Heart Assoc. 2023;12(24):e029891.
doi: 10.1161/JAHA.123.029891
Acknowledgments
6. Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS.
None. Clinical significance of magnetic resonance imaging

Volume 4 Issue 4 (2025) 54 doi: 10.36922/an.4841