MANAGEMENT OF EXTRACRANIAL CERE-BROVASCULAR DISEASE. Edited by Keith Calligaro, Dominic DeLaurentis and William Baker. 217 pp. Illust. Lippincott–Raven Publishers, Philadelphia. 1997. Can$95. ISBN 0-397-51655-X
This compact, readable text contains contributions from 38 authors on a variety of topics concerning the current management of extracranial vascular disease affecting the cerebral circulation. The 19 chapters are divided into 3 parts: preoperative assessment, indications for surgery and surgical technique. A number of important, controversial issues are addressed, and although the opinions expressed by some of the authors cannot be supported fully by published scientific evidence, they will be of interest and provide foci for discussion and further investigation.
The first chapter analyses the costs involved in carotid artery surgery and points out areas for potential savings at all stages, from preoperative testing, through inpatient management to postoperative follow-up. This type of analysis is very useful in defining acceptable practice guidelines at a time when there is a growing gap between what technology can offer patients and what patients and society are willing to pay for medical care. Another chapter in the first part of the text questions the need for preoperative angiography in many patients being considered for carotid endarterectomy. Though clearly controversial, this discussion has important implications for risk management as well as cost control, as a significant component of the overall morbidity of extracranial cerebrovascular surgery is related to angiography.
In the second part of the book, one chapter deals with the emerging interest in transluminal angioplasty and stenting as an alternative to open surgery for extracranial occlusive disease. The authors point out the importance of implementing large randomized controlled trials to determine the relative merits of and specific indications for endovascular versus traditional surgical treatment, while urging that such trials be deferred until adequate expertise is developed in the endovascular procedures to permit their valid assessment.
Although this text focuses on issues in the management of extracranial carotid artery atherosclerosis, it also contains chapters on other types of carotid disease, such as fibromuscular disease and spontaneous dissection, and on disease in other sites, such as the aortic arch and the subclavian and vertebral arteries. Though the scientific basis for the recommendations in these less common conditions is frequently lacking, the editors have invited contributions from authors with extensive experience in these areas whose views are worthy of consideration.
This text will be useful to neurologists, neurosurgeons and vascular surgeons with an interest in cerebrovascular surgery. The book is too specialized and too controversial to be useful as a textbook or standard reference for non-experts.