Small vessel disease is a common cause of cerebrovascular disease. It is responsible for ischemic and hemorrhagic strokes, cognitive decline, and asymptomatic disease. Millions of Americans are affected by silent strokes and white matter abnormalities. Lacunar stroke is the most common manifestation. Despite its importance, small vessel strokes remain understudied. There is a need for research focused on this prevalent stroke subtype to define optimal interventions to prevent stroke recurrence and cognitive impairment.