Cerebral small vessel disease (SVD) damages tiny blood vessels in the brain, limiting blood supply to nearby areas of the brain. Having cerebral SVD increases your risk of both stroke and vascular dementia.

Although we can see the damaged brain tissue on scans, currently there are no treatments that can reverse, stop or even slow down cerebral SVD. This is party because we don’t understand exactly how SVD causes brain damage.

One possibility is that cerebral SVD might make it harder for blood vessels to open as much. This could be causing uneven blood flow or stopping the brain getting rid of waste as effectively.

Research Fellow, Michael Stringer from the University of Edinburgh, is investigating brain scans to understand how brain damage changes over time in stroke survivors with cerebral SVD. He's also exploring the role our body's waste clearance system plays in this disease.

‘Like many people, my family has been affected by stroke and the long-term vascular damage that causes dementia,’ says Michael. ‘Currently, we don’t know why some stroke survivors go on to have more strokes and others don’t – even when they are on the best treatments. I want to find out why the brains of some stroke survivors become more damaged than others.’

To do this, Michael and his team are analysing the brain scans taken soon after stroke, then six and 12 months later, in people whose strokes were caused by SVD.

‘Brain images produce a huge amount information’, explains Michael. ‘Using special types of brain scan, which tell us about how well stroke survivors’ brains are working, we can assess how responsive their blood vessels are. We can also look at whether the protective layer between blood vessels and brain tissue is leaky or not.’

Michael also thinks that the brain's waste clearance mechanism might not be working as effectively in people with SVD. As part of this project, he’s asking some of the stroke survivor participants to come in for an additional three-year follow up to see whether this is the case.

‘We are asking participants to come for another brain scan at three years to measure how waste drains from the brain and how it changes over time. I want to assess whether the waste clearance mechanisms of the brain are lower in patients with more visible brain differences on their scans.

‘I hope this research will help us to find out if there are differences in how well the blood vessels are working, so we can better understand the causes of stroke, develop new treatments, and hopefully prevent strokes in the future.

‘This is one of the first research projects to assess the brain waste clearance system in stroke non-invasively. If the brain’s waste clearance is involved, this may be an important new factor to consider in selecting treatments and developing new drugs.

‘It’s a privilege to be able to work with stroke survivors, their families and other researchers to improve our understanding of what causes stroke. I’ll continue to work with them to make sure the project is guided by their lived experience.’

Find out more

Learn more about Michael’s vital research. And find out how you can get involved in stroke research.

Stroke News magazine

This article is featured in the winter 2025 edition of our magazine, Stroke News. Subscribe to our future editions available in print, on audio CD or via email.