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Arterial, Venous, and Cerebrospinal Fluid Flow and Pulsatility in Stroke-Related Cerebral Small Vessel Disease: A Longitudinal Analysis
Alasdair G. Morgan, Michael J. Thrippleton, Michael S. Stringer, Francesca M. Chappell, Maria del Carmen Valdés Hernández, Stewart J. Wiseman, Lucia Ballerini, Rosalind Brown et al.. Stroke, 2025-06-18
Topic: Brain proteins, microglia and lab models
We recruited 210 participants; 205 (66.8% male; aged 66.4±11.1 years) had useable data. In covariate-adjusted analyses, higher baseline arterial pulsatility was associated with larger volumes of baseline WMH (B=0.26 [95% CI, 0.08–0.44]; P =0.01) and basal ganglia PVS (B=0.12 [95% CI, 0.04–0.20]; P <0.01) but not with their change at 1 year (WMH: B=0.01 [95% CI, −0.05 to 0.06]; P =0.78; basal ganglia PVS: B=0.02 [95% CI, −0.04 to −0.07]; P =0.62) or cognition, dependency, or recurrent stroke at 1 year. Neither cerebral blood flow nor CSF pulsatility was related to baseline SVD severity, WMH/PVS progression, or clinical outcomes at 1 year. Associations between vascular/CSF pulsatility, cerebral blood flow, WMH/PVS, and clinical SVD features are complex. The lack of association between intracranial arterial, venous, or CSF pulsatility, cerebral blood flow, and WMH or PVS longitudinal change in this large, covariate-adjusted analysis questions the presumption that high intracranial vascular pulsatility causes SVD and its progression, consistent with other recent longitudinal studies. Intracranial pulsatility may differ from systemic vascular measures in their cause-pathogenic role(s) in SVD and should be considered separately.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Morgan, A. G., Thrippleton, M. J., Stringer, M. S., Chappell, F. M., Hernández, M. d. C. V., Wiseman, S. J., et al. (2025). Arterial, Venous, and Cerebrospinal Fluid Flow and Pulsatility in Stroke-Related Cerebral Small Vessel Disease: A Longitudinal Analysis. Stroke. https://doi.org/10.1161/strokeaha.124.049103
Vancouver
Morgan AG, Thrippleton MJ, Stringer MS, Chappell FM, Hernández MdCV, Wiseman SJ, et al. Arterial, Venous, and Cerebrospinal Fluid Flow and Pulsatility in Stroke-Related Cerebral Small Vessel Disease: A Longitudinal Analysis. Stroke. 2025. doi:10.1161/strokeaha.124.049103. PMID: 40528792.
BibTeX
@article{morgan2025-40528792,
author = {Morgan, Alasdair G. and Thrippleton, Michael J. and Stringer, Michael S. and Chappell, Francesca M. and Hernández, Maria del Carmen Valdés and Wiseman, Stewart J. and Ballerini, Lucia and Brown, Rosalind and others},
title = {{Arterial, Venous, and Cerebrospinal Fluid Flow and Pulsatility in Stroke-Related Cerebral Small Vessel Disease: A Longitudinal Analysis}},
journal = {Stroke},
year = {2025},
doi = {10.1161/strokeaha.124.049103},
pmid = {40528792},
url = {https://doi.org/10.1161/strokeaha.124.049103}
}
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Key findings
- We recruited 210 participants; 205 (66.8% male; aged 66.4±11.1 years) had useable data.
- In covariate-adjusted analyses, higher baseline arterial pulsatility was associated with larger volumes of baseline WMH (B=0.26 [95% CI, 0.08–0.44]; P =0.01) and basal ganglia PVS (B=0.12 [95% CI, 0.04–0.20]; P <0.01) but not with their change at 1 year (WMH: B=0.01 [95% CI, −0.05 to 0.06]; P =0.78; basal ganglia PVS: B=0.02 [95% CI, −0.04 to −0.07]; P =0.62) or cognition, dependency, or recurrent stroke at 1 year.
- Neither cerebral blood flow nor CSF pulsatility was related to baseline SVD severity, WMH/PVS progression, or clinical outcomes at 1 year.
- Associations between vascular/CSF pulsatility, cerebral blood flow, WMH/PVS, and clinical SVD features are complex.
- The lack of association between intracranial arterial, venous, or CSF pulsatility, cerebral blood flow, and WMH or PVS longitudinal change in this large, covariate-adjusted analysis questions the presumption that high intracranial vascular pulsatility causes SVD and its progression, consistent with other recent longitudinal studies.
Why it matters
Higher arterial pulsatility was linked to more white matter hyperintensities and perivascular spaces at baseline, but not to their change over 1 year or to cognition, dependency or stroke. The authors conclude that these findings question the idea that high intracranial pulsatility causes small vessel disease progression.
Study details
- Study designlongitudinal study
- Participants210
- Effect size66.8%
- Evidence strengthModerate
How this study scored 57/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Stroke) |
| Journal's citation record | 3 / 4 | Stroke: journal h-index 455 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 210 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 2.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Joanna Marguerite Wardlaw: h-index 150 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Edinburgh: institution h-index 1,378 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 4 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40528792) |
| Free to read | 2 / 2 | Free to read |
| Total | 57 / 100 | — |
What each of these 20 components measures, and what this score is not →
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