Small Vessel Disease: Not a Small Problem

Small infarcts in the subcortical area (lacunar infarction) have been considered a relatively simple condition. In most cases, complications associated with warfarin are not a cause for worry, the superiority of angioplasty or stenting need not be disputed, and performing craniectomy is unnecessary; we simply administer an antihypertensive drug and aspirin. However, small subcortical infarcts are not easy to manage. No solid evidence has been presented to support the effectiveness of antiplatelet agents or statin, while the incidence of hemorrhagic complication after the use of antiplatelets is high in this condition. More importantly, the consequences of accumulated small vessel diseases are dismal; many patients suffer from progressively worsening gait difficulty and cognitive/emotional problems. The presence of small vessel disease even worsens the outcome of other stroke subtypes. Last, although genetic causes of small vessel disease are being studied, the existing knowledge on its pathogenesis, diagnosis, and treatment is far from satisfactory. These issues were amply discussed in the International Conference Stroke Update (ICSU) that was held on November 6–8, 2014, in Jeju Island, South Korea. In this issue and in subsequent May issue, we will publish a series of articles regarding small vessel diseases. Most speakers kindly agreed to write on each of the subjects presented at the ICSU 2014. In these papers, the seriousness of small vessel disease will be correctly elucidated. Small vessel disease seems to be more common among Asians than among Caucasians, and rapidly aging populations in this region will considerably increase the burden of accumulating cases of small vessel disease. One of the missions of the Journal of Stroke (JOS) is to more actively present Asian issues, and the series of articles will certainly contribute to this endeavor. Finally, I am pleased to inform you that the JOS was enlisted as an SCI (E) by Thomson Reuters on October 22, 2014. For this, I am indebted to the editorial board members, authors, and members of the Korean Stroke Society, who are excellent, enthusiastic, and devoted contributors and advisers. I am happy to say that all of your articles published in the JOS to date can now be considered “SCI” papers. This excellent news will result in our papers gaining more attention and will attract submission of articles from all over the world. I believe that our constant efforts will make the JOS a truly world-class journal. For this, I would like to suggest a toast!