Small Vessels, Big Questions – Biomarkers, Cerebrovascular Autoregulation and Emerging Therapeutic Targets in Cerebral Small Vessel Disease

Cerebral small vessel disease is increasingly recognised as one of the leading causes of stroke, cognitive impairment and dementia worldwide. Despite its enormous clinical impact, disease-modifying therapies remain limited. In this episode of Voice of Stroke, we explore how advances in biomarker discovery and cerebrovascular physiology are reshaping our understanding of cSVD and identifying promising new therapeutic targets. This episode discusses: The global burden of cerebral small vessel disease Cerebrospinal fluid and blood biomarkers for disease characterisation and progression Cerebral autoregulation as an emerging physiological biomarker The potential role of phosphodiesterase-5 inhibitors and other therapies targeting cerebral vascular function Featuring discussion of recent research published in: International Journal of Stroke Nature Aging Alzheimer's Research & Therapy Frontiers in Neurology Written by: Annemijn Algra, Voice of Stroke Podcast Editor, and Linxin Li, Voice of Stroke Editor-in-Chief. Read the full transcript References 1.        Lam BYK, et al. Global burden of cerebral small vessel disease determined from large MRI studies: A systematic review and meta-analysis. International Journal of Stroke. 2026. 2.        Hristovska I, et al. Identification of distinct and shared biomarker panels in different manifestations of cerebral small-vessel disease through proteomic profiling. Nature Aging. 2026. 3.        Yang D, et al. Plasma extracellular vesicle proteins biomarker for cerebral small vessel disease related cognitive impairment. Alzheimer's Research & Therapy. 2026. 4.        Webb AJS, et al. The role of impaired autoregulation in cerebral small vessel disease and vascular cognitive impairment. International Journal of Stroke. 2026. 5.        Yan L, et al. Phosphodiesterase-5 inhibitors for cerebral small vessel disease-related ischemic stroke and cognitive decline: Systematic review and meta-analysis. Frontiers in Neurology. 2026.