Cerebral small vessel disease (CSVD) refers to a series of clinical imaging pathological syndromes caused by various etiologies affecting cerebral small vessels, which have the characteristics of insidious onset, high incidence and easy recurrence. Insulin resistance (IR) is a decrease in the body's sensitivity to insulin. In recent years, more and more studies have confirmed that IR is associated with the occurrence and development of imaging features of CSVD, but the mechanism is still unclear. This article reviews the relationship between IR and cerebral small vessel disease and its possible mechanism, in order to provide reference for the prevention and treatment of cerebral small vessel disease.