Mukherji SK, consulting ed. Chaudhary N, Gemmete JJ, guest eds. Endovascular Management of Neurovascular Pathology in Adults and Children. Elsevier; November 2013. Neuroimaging Clinics of North America; vol. 23; no. 4; pgs. 563–562; $489.
For those who are either involved directly with interventional neuroradiology or who are working exclusively in diagnostic neuroradiology, this issue of the Neuroimaging Clinics of North America, entitled Endovascular Management of Neurovascular Pathology in Adults and Children, will be of great interest. Even with the understanding that the devices and material used in various types of endovascular therapies change rapidly from year to year and that indications for vascular therapies undergo frequent reassessment, many valuable and critical lessons are contained in this issue.
Edited by Drs. Chaudhary and Gemmete, both from the University of Michigan, with contributions from 37 authors, the material covers in 15 chapters endovascular approaches to intracranial aneurysms, vasospasm, AVMs, AVFs, extracranial carotid disease, extracranial vascular disease, arterial dissections, acute stroke, balloon test occlusions, vascular anomalies, spinal vascular lesions (including spinal AV shunts), cerebral AVMs, aneurysms, and stroke.
Prior to reading each chapter, one can get an indication of what will be contained in those chapters by reading the introductory paragraph in the Table of Contents as well as the key points, usually numbering five to fifteen, at the beginning of each chapter. As one would expect, the imaging included (both pre-, intra-, and post-intervention) are crisp, supplemented by highly descriptive legends. Fortunately, the images are not overloaded with labeling, which helps one to clearly see the vascular structures near the abnormalities.
The educational value contained in this book is exemplified and explained by reading the chapter “Endovascular Methods for the treatment of Intracranial Cerebral Aneurysms.” Here the potential options for therapy (coiling, flow diversion, stents with coiling, balloon remodeling, liquid therapy with Onyx), are described, rationalized, and illustrated. Besides reviewing the natural history of aneurysms and the risks for patients with such lesions, the reader learns of the technical challenges involved and the diagnostic information required to proceed with proper therapy. While much of the information is second nature to those who do high-volume interventional neuro work, the discussion provides solid groundwork for the diagnostic neuroradiologist, who commonly does not appreciate the intricacies of the treatment of these lesions. Parenthetically, this statement pertains not just to the aneurysm chapter but to the subsequent chapters as well.
In one chapter, important statistics relative to natural history, incidence, associated diseases, association with SAH, frequency of rebleeds, consideration in unruptured aneurysms, and risks are discussed. Two-and-one-half pages summarize the vital information on intracranial aneurysms from a natural history perspective. As one would expect, the thrust of this chapter is towards treatment and, therefore, the material is subdivided into sections dealing with coiling of simple saccular aneurysms, coiling of wide neck aneurysms, stent-assisted coiling, liquid embolic agents (Onyx), and flow diversion. The chapter ends with a 2-page discussion of complications associated with coiling. The key information is the description of the various techniques along with procedural/preprocedural management techniques and how specifically each of the above is done—the reader will realize that the techniques preferred in endovascular aneurysm treatment are different from institution to institution. The authors take the reader step-by-step through the procedure; so, in the coiling of a simple (non-wide neck) aneurysm, we read of the pre-embolization imaging/preparation, then, in sequence, the microcatheter placement, selection of coils, coil detachment, and, finally, the overall results/outcome of such treatment in ruptured and unruptured aneurysms. The accompanying images are adequate for demonstrating the steps used in the treatments.
The excellent level of writing and descriptions exemplified by the chapter described above is repeated through succeeding chapters, thus serving as a strong reference for all those in neuroradiology.
Continuing in the long series of successful publications in the Neuroimaging Clinics of North America (NICNA), this issue is particularly noteworthy. It is to the Editors’ credit that they assembled this valuable text.
