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ESO Guideline on covert cerebral small vessel disease
Wardlaw JM, Debette S, Jokinen H, De Leeuw FE, Pantoni L, Chabriat H, Staals J, Doubal F et al.. European stroke journal, 2021-05-11
Topic: Brain proteins, microglia and lab models
'Covert' cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Wardlaw, J. M., Debette, S., Jokinen, H., De Leeuw, F. E., Pantoni, L., Chabriat, H., et al. (2021). ESO Guideline on covert cerebral small vessel disease. European stroke journal. https://doi.org/10.1177/23969873211012132
Vancouver
Wardlaw JM, Debette S, Jokinen H, De Leeuw FE, Pantoni L, Chabriat H, et al. ESO Guideline on covert cerebral small vessel disease. European stroke journal. 2021. doi:10.1177/23969873211012132. PMID: 34414301.
BibTeX
@article{wardlaw2021-34414301,
author = {Wardlaw, J. M. and Debette, S. and Jokinen, H. and De Leeuw, F. E. and Pantoni, L. and Chabriat, H. and Staals, J. and Doubal, F. and others},
title = {{ESO Guideline on covert cerebral small vessel disease}},
journal = {European stroke journal},
year = {2021},
doi = {10.1177/23969873211012132},
pmid = {34414301},
url = {https://doi.org/10.1177/23969873211012132}
}
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Key findings
- We found little direct evidence, mostly of low quality.
- We found little evidence on lipid lowering in ccSVD.
- In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments.
Why it matters
These guidelines found little direct evidence, mostly of low quality, about managing covert cerebral small vessel disease to prevent outcomes like cognitive decline or dementia. They recommend good blood pressure control in patients with this condition and hypertension, do not recommend antiplatelet drugs such as aspirin, and found no evidence for glucose control without diabetes or for conventional Alzheimer dementia treatments.
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Study details
- Evidence strengthHigh
How this study scored 55/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (European stroke journal) |
| Journal's citation record | 0 / 4 | European Stroke Journal: journal h-index 60 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 169 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 24.1 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 4 / 6 | Cited 11.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 3 / 4 | Cited 104 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Arne G. Lindgren: h-index 56 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Inserm: institution h-index 1,988 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 29 institution(s) in 8 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 34414301) |
| Free to read | 2 / 2 | Free to read |
| Total | 55 / 100 | — |
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Read the original
- DOI: 10.1177/23969873211012132
- PubMed: 34414301
- Original source →
- Free full text: European Stroke Journal →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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