Skip to main content

Research Repository

Advanced Search

Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions

Bath, Philip M.W.; Wardlaw, Joanna M.

Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions Thumbnail


Authors

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine

Joanna M. Wardlaw



Abstract

Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. It causes a quarter of all ischemic strokes, is the commonest cause of vascular dementia, and the cause is incompletely understood. Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. Further, intensive antiplatelet therapy is known to be hazardous in small vessel disease through enhanced bleeding. Whether acetylcholinesterase inhibitors, which delay the progression of Alzheimer's dementia, are relevant in small vessel disease remains unclear. Potential prophylactic and treatment strategies might be those that target brain microvascular endothelium and the blood brain barrier, microvascular function and neuroinflammation. Potential interventions include endothelin antagonists, neurotrophins, nitric oxide donors and phosphodiesterase 5 inhibitors, peroxisome proliferator-activated receptor-gamma agonists, and prostacyclin mimics and phosphodiesterase 3 inhibitors. Several drugs that have relevant properties are licensed for other disorders, offering the possibility of drug repurposing. Others are in development. Since influencing multiple targets may be most effective, using multiple agents and/or those that have multiple effects may be preferable. We focus on potential small vessel disease mechanistic targets, summarize drugs that have relevant actions, and review data available from randomized trials on their actions and on the available evidence for their use in lacunar stroke.

Citation

Bath, P. M., & Wardlaw, J. M. (2015). Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. International Journal of Stroke, 10(4), https://doi.org/10.1111/ijs.12466

Journal Article Type Article
Acceptance Date Jan 6, 2015
Online Publication Date Mar 2, 2015
Publication Date Jun 1, 2015
Deposit Date Aug 4, 2016
Publicly Available Date Aug 4, 2016
Journal International Journal of Stroke
Print ISSN 1747-4930
Electronic ISSN 1747-4949
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 10
Issue 4
DOI https://doi.org/10.1111/ijs.12466
Keywords antithrombotics, blood brain barrier, blood pressure lowering, cyclic nucleotide inhibitors, nitric oxide, prostacyclin
Public URL https://nottingham-repository.worktribe.com/output/983262
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/ijs.12466/abstract

Files

Int J Stroke-2015-Bath-469-78.pdf (436 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





You might also like



Downloadable Citations