Gonzalez RG, Hirsch JA, Lev MH, Schaefer PW, Schwamm LH, eds. Acute Ischemic Stroke Imaging and Intervention, Second Edition. Springer 2011, 297 pages, 138 illustrations, $169.00
Drs. Gonzalez, Hirsch, Lev, Schaefer, and Schwamm have edited book on what can be considered the most vital issue in diagnostic and therapeutic neuroradiology—that is the imaging evaluation and treatment of the acute brain ischemia. Along with 22 co-authors, the editors have addressed all of the points one should consider in evaluating acute ischemia stroke. Importantly, a sizeable portion of the book (the last 78 pages) deals with therapeutic approaches to acute ischemic stroke. This includes separate chapters on: IV thrombolysis, imaging for endovascular stroke therapy, and endovascular approaches to acute stroke. These 3 chapters contain the latest evidence-based information on therapeutic strategies and are important whether one is involved in the actual treatment and management of these patients or not.
The material in this book should be known to a reasonable extent by all neuroradiologists. Despite the ever changing devices, strategies, and pharmalogical agents, the current practice (as of 2011) is well described both in the strictly imaging areas and in the therapeutic areas and will be useful to refer to, at least for the near future.
In addition to the 5 editors, there are multiple authors from other medical centers and from other disciplines (predominately Neurology), which adds to the inter-disciplinary nature of the book. Perhaps it was an oversight, but these co-authors are not listed separately in the beginning of the book. There are 13 chapters: Ischemic Stroke/Basic Pathophysiology, Causes of Ischemic Stroke, Unenhanced CT of Ischemic Stroke, CTA; CT Perfusion, Convention MR and MRA, Diffusion MR Imaging, Perfusion MR, The Clinical Ischemic Penumbra, Clinical Management, and the 3 chapters mentioned earlier which deal with treatment of acute ischemic stroke. Two of the chapters are new (Penumbra and Endovascular Therapy) and others have been updated. In contradiction to other textbooks in Radiology, most of which commonly serve as reference texts to look up certain material, this book can and probably should be read chapter-by-chapter, cover-to-cover. There are many chapters which will interest the diagnostic neuroradiologist or stroke neurologist/neurosurgeon; some of the material goes over information which is known by many (but is still highly worthy reviewing) while some other material is on the cutting edge of imaging technology and deserves special attention by all.
Consider the new chapter on the clinical ischemic penumbra. Here is the historical background, the clinical setting, the experimental work, and the application of these “penumbral” concepts to imaging and therapy. Discussed are issues such as prolonged time of diffusion/perfusion mismatch and the variability between patients. Driven home is the fact (among others) that a penumbra maybe stable and some diffusion abnormalities may not enlarge over time. We are introduced to the concept of a clinical-DWI mismatch and its relation to perfusion-diffusion mismatch and further to the MRA-DWI mismatch. Implications for therapy are discussed, and we can expect that this latter metric could be increasingly used in judging therapeutic options. This chapter is well written, easily read, and contains images which illustrate the points made in the chapter.
The chapter on endovascular approaches to acute stroke discusses the background for endovascular therapy. Starting with remarks about the relative ineffectiveness and even detrimental effect when considering of IV and PA, large population groups, timing issues, and the low usage of IV and tPA, the authors then proceed to describe endovascular approaches which could be used to better effect and/or could be used in patients who might not fall under IV therapy guidelines. In addition, percentage of patients with acute brain ischemia who actually receive intravenous thrombolytic therapy is so small that other methods/approaches can be considered, such as antegrade reperfusion, flow augmentation, and transvenous retrograde reperfusion. How each of these are achieved is the focus of this chapter. One learns of the many new devices/protocols associated with these endovascular approaches. The advantage of, for example, direct intra-arterial lytic agents or mechanical disruption is explained along with how such techniques expand the commonly accepted 3-hour window for therapy.
This complete and well written book should appeal to all those involved with stroke evaluation and therapy: radiologists, neurologists, and neurosurgeons alike. For neuroradiologists purchase is highly recommended, and this book should be available for ready reference.
