Cerebral Revascularisation

This volume presents current information on cerebral revascularisation. It deals with new aspects of pathophysiology, cerebral ischaemia, investigation and therapy - medical and surgical - of patients with both symptomatic and asymptomatic cerebrovascular disease. It consists of 56 chapters written by experts in the field and is aimed at vascular surgeons, vascular internists, vascular technologists, vascular radiologists, neurologists, neurophysiologists, epidemiologists, cardiologists and all their trainees. Each chapter reviews the literature, summarizing the results of recent research and providing recommendations on the practical management of patients. This multidisciplinary work illustrates how recent progress has made the prevention of stroke possible.

Table of Contents:
Foreword, H.J.M. Barnett. Part 1 Pathophysiology: epidemiology and costs of stroke; stroke from carotid bifurcation disease; pathology of carotid bifurcation disease; haemodynamic carotid insufficiency; biochemical and physiological activities of the brain as in vivo markers of brain pathology. Part 2 Investigation: noninvasive evaluation of extracranial arterial disease - overview; transcranial Doppler; plaque characterization - does it identify high risk groups; arteriography in the evaluation of extracranial cerebrovascular disease; relative value of duplex scanning and angiography; the value of CT-scanning; the cardiac assessment of patients with carotid stenosis. Part 3 Medical therapy: overview; the value of medical therapy; brain protection from ischaemia-reperfusion; the management of vertebrobasilar ischaemia; the management of carotid and vertebral artery dissection; polymers as controlled drug delivery systems for the brain; atherosclerotic occlusive lesions of brachiocephalic arteries - surgical or medical treatment. Part 4 Surgical therapy: the beginning of carotid surgery; role of preoperative angiography in carotid endarterectomy; cerebral protection during anaesthesia for carotid and vertebral surgery; current techniques of carotid endarterectomy; closure of carotid endarterectomy - patch versus primary closure; lateral arteriotomy for carotid endarterectomy; recurrent carotid stenosis; long term results; the timing of carotid endarterectomy; surgery of vertebral artery anomalies; redundant carotid and vertebral arteries; irradiation to the carotid arteries; the value of carotid endarterectomy in symptomatic patients; traumatic lesions of extracranial arteries; surgery of brachiocephalic and vertebral arteries. Part 5 Asymptomatic carotid stenosis: the prevalence of asymptomatic carotid artery disease; the significance of the cervical bruit; outcome in patients with asymptomatic carotid stenosis; natural history of patients who had carotid endarterectomy and have a contralateral asymptomatic stenosis; lessons from symptomatic carotid stenosis of interest in considering asymptomatic disease; the value of ultrasonic scanning in stroke prediction in the asymptomatic patient; the risk (immediate and longterm) of asymptomatic stenosis in patients having major cardiac or peripheral vascular surgery; implications of the CHAT classification in the asymptomatic patient; the risk of carotid endarterectomy in asymptomatic patients; are there any carotid lesions technically too difficult for repair in the asymptomatic patient?; the results of asymptomatic operations; the VA cooperative trial; the ACAS study; overview - the management of patients with asymptomatic carotid stenosis. Part 6 Recent trends and developments: combined extra-intracranial lesions; total occlusion of the internal carotid artery - an approach to treatment; EC-IC bypass surgery revisited. (Part contents).