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STROKES: A NEW CAUSE DISCOVERED





 For decades, doctors have believed that a common type of stroke was caused by fatty plaque clogging up arteries. But new research from the University of Edinburgh flips that idea on its head. It turns out the real culprit might be something much deeper — tiny blood vessels in the brain that are damaged and enlarged.

This discovery could explain why standard treatments, like aspirin, often fall short for this type of stroke. Instead of battling clogged arteries, scientists now think the key lies in directly protecting these fragile little vessels.

The type of stroke in question is called lacunar ischemic stroke. It happens when the brain’s smallest blood vessels get damaged through a condition known as small vessel disease. This stroke isn’t just a one-off event — it’s a major cause of long-term disability and is linked to memory loss, dementia, and a higher chance of future strokes.

A team led by researchers from Edinburgh, together with international collaborators, studied 229 stroke patients. They used brain scans and cognitive tests right after strokes and again a year later. They looked closely at two things: whether arteries were narrowed by fatty plaque and whether arteries deep in the brain were enlarged and stretched.

What they found was surprising. Narrowed arteries, which doctors have long blamed, didn’t line up with lacunar strokes or ongoing brain damage. But patients with widened arteries were four times more likely to have had this kind of stroke. Widened arteries also meant more severe brain vessel damage, faster worsening of brain injury, and a higher chance of “silent” strokes—tiny brain injuries that don’t show obvious symptoms but add up over time.

Even more striking, more than one in four patients developed these silent strokes during the study, despite being on standard stroke prevention meds.

These insights are already shaping new treatments. One trial, called LACI-3, is testing drugs that aim to shore up the brain’s smallest vessels, hoping to reduce the risk of more strokes and the devastating long-term effects on memory and movement.

Joanna Wardlaw, a leading neuroimaging expert at Edinburgh, put it plainly: “Lacunar stroke isn’t about fatty blockages in big arteries. It’s about disease in the brain’s tiny vessels. That’s why aspirin and similar drugs often don’t work well. We urgently need treatments that focus on these microvessels.”

This breakthrough, published in Circulation, brings fresh hope to the millions affected by these strokes. Funded by major health organizations across the UK and beyond, the research team included experts from China and Mexico, highlighting the global importance of cracking this mystery.

The story of lacunar stroke is shifting. The challenge now is to turn this new understanding into better care — before more lives are changed by these silent, hidden attacks on the brain.

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