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Page 2 of 3 Scullen et al. Vessel Plus 2020;4:9 I http://dx.doi.org/10.20517/2574-1209.2020.07

translational investigations and clinical advancement.

Along with an understanding of disease basic science, modern clinical practice mandates introspective
evaluation of current practice. Such methods allow for the identification of areas of improvement in
[3]
treatment and prevention strategies. Im et al. investigated the compliance and appropriate prescription of
aspirin in the primary prevention of cerebrovascular and cardiovascular disease. The authors prospectively
analyzed the baseline demographics of 1125 patients without prior vascular disease undergoing physicals
[3]
with primary care physicians at their center . Using patient demographics, the authors evaluated
[3]
discrepancies in aspirin use at the time of their routine medical checkup . The authors found that, while
[4]
aspirin administration was indicated in 23.6% of patients, only 3.9% of patients were actively taking the
[3]
drug . Investigation of this discrepancy illustrated that only 10% of patients were appropriately prescribed
aspirin based on current international guidelines, and thus through secondary calculation reasoned that
[3]
6% in total were taking the medicine appropriately . The authors suggested that improvement in primary
prevention may be made through increased education on aspirin use, at the level of both the prescriber and
[3]
the patient . Such studies provide opportunities in the prevention of complex cerebrovascular disease by
highlighting areas where active guidelines are not being employed efficiently.

Similarly, effective selection of patients to undergo primary prevention of treatment measures allows
for efficient resource management and decreases risks of adverse events. As such, growing interest in
radiographic and molecular biomarkers has sparked interest in multiple aspects of cerebrovascular disease.
[5]
In their prospective analysis, Mueller et al. sought to characterize radiographic features and various
potential serum biomarkers and their association with clinical presentation of atherosclerotic carotid
disease. Transcranial ultrasound bubble studies and radiotracer computer tomography angiography were
utilized to evaluate the stability of plaque formation in symptomatic and asymptomatic patients with
[5]
clinically significant carotid stenosis . Given the uncertain nature regarding the stability of atherosclerotic
plaques and their tendency to rupture and produce atheroembolic events, the subject has seen significant
interest in active studies involving the evaluation of prognostic factors and underlying biology in plaque
[6]
formation . The authors chose to compare important clinical indicators, such as propensity of microemboli
formation, with biomarkers under investigation, concluding that ICAM-1 was associated with thrombotic
[5]
plaque formation .
As an adjunct to active research, case reports provide valuable anecdotal evidence of the variable
[7]
presentation and management techniques of disease. Candelaresi et al. presented a well written report of
a patient who developed posterior reversible encephalopathy syndrome attributable to the administration
of the myeloma protease inhibitor bortezomib. The case details the clinical course and association with
[5]
drug and discusses potential mechanisms . The patient in the case was ultimately successfully treated with
[5]
systemic glucocorticoids , a convenient option as such drugs are often a component of anti-myeloma drug
regimens.
Cerebrovascular disease has undergone a recent and synergistic increase in disease understanding and
treatment options. Such phenomena are only possible with continued and persistent multidisciplinary
academic interest. Critical literature takes a variety of forms. Literature reviews provide a concise and
relevant presentation of basic science knowledge of disease processes and may provide functional benefit
to other basic scientists, clinicians, and translational scientists. Introspective evaluations of current disease
practices allow quality improvement and an effective utilization of active management strategies. Studies
identifying and validating disease biomarkers are increasingly necessary given the heterogeneous nature of
multiple disease processes to assure effective patient selection and resource allocation. Finally, case reports
allow investigators to be aware of variations of disease presentations and effects of seemingly unrelated
events to provide anecdotal evidence that may affect clinical decision making or inspire connections in