ABSTRACT NUMBER: ESOC2026A785 THE IMPACT OF AORTIC STIFFNESS AND STRUCTURAL AORTIC CHANGES ON CEREBRAL SMALL VESSEL DISEASE AND LACUNAR STROKE: A LITERATURE REVIEW

Abstract Background and aims Lacunar strokes are a major subset of ischemic strokes, driven primarily by small vessel pathology. While hypertension and aging are key risk factors, structural and functional changes in central arteries, particularly aortic stiffness and aortic root dilation, may contribute to cerebral small vessel disease (CSVD). To review current evidence regarding the association between aortic stiffness, aortic root dilation, and lacunar stroke. Methods Literature review of observational studies, cohort studies, and meta-analyses examining central arterial properties, including aortic stiffness (pulse wave velocity), structural aortic remodeling, and their relationship with lacunar infarcts or CSVD markers. Results Increased aortic stiffness is consistently associated with CSVD markers, including lacunes and white matter hyperintensities. Although direct evidence linking aortic root dilation to lacunar stroke is limited, dilation is often associated with increased stiffness and altered hemodynamics, suggesting an indirect contribution. Conclusions Arterial stiffness and related aortic remodeling may play a significant role in CSVD pathophysiology. Assessment of central arterial properties may enhance stroke risk stratification and inform preventive strategies. Further longitudinal studies are warranted to clarify the independent impact of aortic root dilation on lacunar stroke risk. Conflict of interest Elly El-rekaby: nothing to disclose