Proposed model of progressive cerebrovascular disease in iTTP and opportunities for intervention. Ischemia occurs during acute iTTP, but additional lesions (in the same or other sites) may occur during remission and contribute to cognitive deficits. Based on shared pathophysiology, SCI is a likely precursor lesions for stroke. Potential factors contributing to ischemic injury are highlighted in yellow. Targeting microvascular thrombi in acute iTTP could reduce SCI from the acute event and targeting remission ADAMTS13 and other cardiovascular risk factors could mitigate ongoing injury during remission.