Cerebral small vessel disease (SVD) is a very common group of neurological diseases in older people, linked to dementia onset, stroke occurrence, cognitive decline, and psychiatric disorders. SVD accounts for up to 25% of all ischemic strokes and is an underlying pathology in most hemorrhagic strokes in older people and thus, is a very important area of stroke research. Joanna Wardlaw, CBE, MD, FRCP, FRSE, FMedSci, University of Edinburgh, Edinburgh, UK, discusses the progress being made in this area, explaining how an improved understanding of the etiology and pathogenesis of SVD is leading to better ways to maintain the health of these vessels. This interview took place at the European Stroke Organisation Conference (ESOC), 2021.