Predictors of Stroke Recurrence and Outcomes in Cerebral Small Vessel Disease: A Systematic Review of the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial Findings

Abstract

Cerebral small vessel disease (CSVD) plays a significant role in the development of lacunar strokes and is closely associated with cognitive decline, gait disturbances, and vascular dementia. This systematic review explores the pathophysiology and management of CSVD, with a focus on its contribution to stroke recurrence and patient outcomes. Key findings indicate that structural cardiac abnormalities, inflammatory markers, and metabolic disorders are critical predictors of stroke risk in individuals with CSVD. Structural changes in the heart, such as altered left ventricular geometry, are linked to higher stroke recurrence rates, while elevated inflammatory markers, like high-sensitivity C-reactive protein, are associated with increased vascular events. Metabolic conditions, particularly diabetes, correlate with more severe vascular abnormalities and a heightened risk of recurrent strokes and mortality. Notably, some treatment strategies, such as dual antiplatelet therapy, may inadvertently increase mortality in specific patient groups, underscoring the importance of individualized therapeutic approaches. These insights emphasize the multifactorial nature of CSVD and highlight the need for comprehensive risk assessments and targeted management strategies to improve clinical outcomes.