The Handbook of Cerebrovascular Diseases offers the second edition of one of a series of volumes on neurologic disease and therapy produced by the publisher. The editor and most of his 74 contributing authors seem to be neurologists writing for neurologists and perhaps the occasional primary care internist or family practitioner with an interest in this area. In fact, the few surgical contributors seem to be neurosurgeons with previously published expertise in extracranial and intracranial cerebrovascular disease. Unfortunately, it is difficult to be certain of the training background of contributing authors; this information is not provided. This comprehensive book is not limited to discussion of extracranial carotid artery disease but, considering its audience, also includes hemorrhagic and ischemic disease from etiologies as diverse as intracranial aneurysm, amyloid angiopathy, mitochondrial encephalopathy, and valvular heart disease. The book begins with epidemiologic factors and cerebrovascular anatomy, followed by an excellent discussion of currently available diagnostic modalities and general patient management principles and enhanced by a specific focus on the treatments available for ischemic and hemorrhagic etiologies. Additional chapters discuss cognitive impairments, neuropsychiatric disorders, and rehabilitation after stroke. There is some repetition between chapters, but overall the organization seems to flow well, with one chapter complementing the next. Many of the chapters follow an evidence-based medicine format, especially the ones addressing treatment of acute ischemic stroke with thrombolysis, anticoagulants, and antiplatelet agents. All of this is presented at a level that is comprehensible without being too simplistic to the average nonneurologist reader. However, there seems to be a definite bias against surgical treatment, especially of asymptomatic extracranial carotid artery occlusive disease. In fact, the less-than-enthusiastic discussion of the multiple prospective, randomized trials of this entity yields a much more negative interpretation of the existing level 1 data than is generally found elsewhere. However, it is probably vital for cerebrovascular surgeons to be aware of the roots of this controversy. Furthermore, whereas the chapter dedicated to surgical management options to prevent ischemic stroke runs a scant four pages of discussion laying out the extensive evidence supporting the argument for carotid endarterectomy, a full 48 pages (exclusive of references) is set aside for carotid angioplasty and stenting, sadly consisting primarily of anecdotal experience and supposition. Issues of carotid artery revascularization familiar to the practicing surgeon—including the nature of the plaque, patch repair, type of anesthetic, shunting, intraoperative monitoring, and imaging—are not included. Despite these limitations, the primary value of this book to the extracranial surgeon remains the excellent up-to-date discussion of the risk factors for cerebrovascular disease and the current status of medical therapies for the prevention and treatment of stroke. These two strengths alone make it worthy of consideration for purchase.
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