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Figure 2. Mechanisms of aberrant BBB dynamics in CSVD. This illustration portrays the correlation between the BBB and the glymphatic system within the framework of common risk factors for CSVD, like hypertension, diabetes, and aging. These factors may result in the dysfunction of the NGVU and the dynamics of the glymphatic system, such as reduced polarization of AQP4, ePVS, and increased BBB permeability. The right panel connects these alterations with endothelial cells and the decrease of the lumen size, depicting the mechanism including endothelial activation, endothelial dysfunction, oxidative stress, and CBF alteration, which collectively lead to a cascade of inflammatory and thrombotic responses, culminating in impaired vasodilation and potentially contributing to CSVD disease progression.