Secondary Prevention of Lacunar Stroke

The pathophysiology of lacunar stroke, a clinical syndrome strongly linked with small vessel disease (SVD), is still not entirely understood. Over the last years, the increasing interest in SVD has led to underline the need of a deeper knowledge in lacunar stroke prophylaxis. To date, most data derive from post-hoc analysis of studies including different subtypes of stroke (often without neuroimaging verification), and from a few trials specifically designed for SVD and lacunar stroke. Hypertension is a major risk factor for SVD, and lowering blood pressure has been proven effective in preventing lacunar stroke recurrence. Statin use is safe in patients with lacunar stroke and should be considered. Single antiplatelet therapy is the mainstay of secondary prophylaxis, while double antiplatelet therapy is associated with increased hemorrhagic risk without advantages. More studies specifically addressed to SVD and lacunar stroke prophylaxis are needed to implement the evidence in clinical practice and to better target secondary prevention measures.