The body is an intricate system of tiny blood vessels no wider than a strand of hair that help deliver oxygen to the tissues, shaping thoughts, memories and movements. When these pathways fail, the consequences can be life-threatening.
Now, scientists believe they may have uncovered a surprising cause behind one of the world's most feared conditions, which affects approximately 35,000 people across Britain each year.
A research team at the University of Edinburgh has revealed lacunar strokes, which damage tiny blood vessels deep within the brain, could stem from arteries dilating rather than being blocked.
The revelation challenges conventional understanding of the condition and may explain why standard treatments have proven ineffective.
Lacunar strokes represent roughly one-fifth of all strokes nationally
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Lacunar strokes represent roughly one fifth of all strokes nationally, according to British Heart Foundation estimates, and can cause lasting difficulties with cognition, memory and movement, potentially progressing to dementia.
The latest investigation tracked 229 individuals who had suffered either a lacunar or mild non-lacunar stroke.
Each participant underwent comprehensive brain imaging and cognitive assessments at the time of their stroke, with follow-up examinations conducted twelve months later. Researchers monitored indicators of small vessel disease alongside any fresh areas of brain damage.
Their analysis revealed a striking pattern: enlargement of arteries, rather than constriction, was associated with lacunar stroke.
Those with widened arteries faced a fourfold increase in their likelihood of experiencing this type of stroke.
The study also uncovered more than a quarter of patients suffered silent strokes during the research period, despite receiving preventative treatment.
Professor Joanna Wardlaw, who leads applied neuroimaging at Edinburgh's Institute for Neuroscience and Cardiovascular Disease and serves as group leader at the UK Dementia Research Institute, said: "This study provides strong evidence that lacunar stroke is not caused by fatty blockage of larger arteries, but by disease of the small vessels within the brain itself.
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"Recognising this distinction is crucial, because it explains why conventional treatments like anti-platelet drugs are not as effective for this type of stroke and highlights the urgent need to develop new therapies that target the underlying microvascular damage."
The findings have been published in the journal Circulation.
Maeva May, Director of Policy at the Stroke Association, said: "Stroke research is chronically underfunded, with less than one per cent of total UK research funding spent on the condition.
Some strokes could stem from arteries becoming wider rather than blocked
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"Yet these findings illustrate the value of research and the potential it has to change the lives of stroke patients.
"This study and more of its kind need to be a national priority across the NHS, government and the wider research community with clear pathways to carry breakthrough discoveries from laboratory to patients."
The research is already informing further clinical work, including the LACunar Intervention Trial 3, which is examining whether existing medications might prove effective against this particular form of stroke.
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