BOOK REVIEWSJames O. Menzoı́an, MD, Book Review Section Editor

Stroke, your questions answeredGraeme J. Hankey; Philadelphia, Pa; Elsevier Science; 360pages; $29.95.

As the title of this book suggests, Stroke, your questions an-swered aims to enlighten the reader regarding most, if not all, of themajor issues involved in this disease. At the outset, the author notesthat the book is written with the general medical practitioner inmind. Overall, the book is a hybrid between a handbook, to becarried in one’s white coat, and a reference text.

Each chapter is organized into a set of subtopics, which beginwith a group of questions that the author then answers, in order,usually in a paragraph or two. For example, in Chapter 4 (of 16chapters), in the subheading “Carotid and Vertebrobasilar Terri-tory Ischemia,” the eighth question is “How reliable is the clinicaldistinction between carotid and vertebrobasilar territory TIAs?”The author then answers the question in a single paragraph,referencing a study that demonstrates that it is not reliable. Thisscheme is followed throughout the book.

In terms of scope and depth, the book certainly succeeds in itsmission as a quick reference tool for anyone in the medical fieldwho deals with stroke. Although each question is answered briefly,the aggregate of questions in each chapter allows the author to giveeach topic a reasonably deep treatment. However, vascular sur-geons will likely find the book somewhat limited. The role ofsurgery in stroke management and prevention is given brief treat-ment and with a medical bias. The indications for carotid endar-terectomy are outlined briefly in chapter 14. The author states thatin asymptomatic disease “the overall risks and benefits from carotidsurgery are quite evenly balanced and may not favor carotid surgeryuntil several years have passed.” This statement references theresults of a meta-analysis published in 1998 in the British MedicalJournal.

Despite this criticism, I found the book enjoyable to read andinformative. The author writes with authority and, where it isavailable, relies on the most up-to-date and well-designed studiesto support his views. The book can be read cover-to-cover in ashort time, but it is also designed for users who want to find aspecific answer to a question that might be raised in the manage-ment of a patient with stroke.

Many of the chapters conclude with a short section titled“Patient Questions.” In this section the author lists a number ofquestions that a patient would ask regarding the topics of thechapter, then answers them in layman’s terms. This seems unnec-essary in a book written for physicians as a quick reference forinformation about stroke.

Overall, I enjoyed reading Stroke, your questions answered. Thebook covers the major topics of the subject in clear, conciselanguage that should be understood by any physician. Vascularsurgeons will likely find the book somewhat limited, for reasonsmentioned above.

Christopher Gram, MD

Boston Medical CenterBoston, Mass

10.1016/S0741-5214(03)00467-1

Vascular grafts: Experiment and ModelingA Tura Ladseb; Southhampton, United Kingdom; WIT Press;440 pages; £213.

The 2003 text, Vascular Grafts: Experiment and Modeling,edited by Professor A. Tura Ladseb of Padua, Italy, is a welcome

addition to the small number of published texts devoted to thetopic of vascular prosthesis. The book is a recent volume in theongoing International Series on Advances in Fluid Mechanics fromWIT Press. As one might expect, therein lie both the strengths andweaknesses of this text. Each of the 10 chapters, separately au-thored, focuses in great detail on hemodynamic and biomechanicalaspects of synthetic vascular graft design and performance, with arelative paucity of discussion of a number of other biologic pro-cesses relevant to vascular graft design and efficacy. Minimal atten-tion is given to key biologic issues of surface thrombogenicity,inflammatory processes, or effects of graft chemistry on proteinadsorption, platelet activation, or cellular differentiation.

The overall structure of the volume is five chapters devoted toexperimental data balanced by five chapters focusing on mathemat-ical modeling. The chapters tend to overlap in part, with introduc-tory sections that are repetitive. But this is a minor shortcoming aseach chapter then develops its own separate focus. Either by intentor coincidence, almost every chapter begins with a statement thatcompliance and compliance mismatch are the most importantgraft-related parameters affecting clinical efficacy. There is nosuggestion that this statement might be controversial. Each indi-vidual chapter then presents experiments and/or mathematicalapproaches—primarily those used by the chapter authors but sup-plemented by literature reviews—by which to assess the relation-ships between hemodynamic parameters, prosthetic wall bio-mechanisms, anastomatic geometries, and a variety of stenoses andthe effects of these conditions on graft thrombosis or intimalhyperplasia. The text is a very valuable consolidation of theseimportant concepts into a single volume. However, only six of thechapters provide any real discussion of biologic mediators linkingphysical forces to cellular responses, and the discussions are highlysuperficial in even these chapters.

Nonetheless, it is perhaps unfair to fault the editor and authorswith the observation that the volume is less biologically inclusivethan are other recently published texts. The intent of this book is,after all, to focus on biomechanical and fluid mechanical aspects,and this is done well. Of particular interest are the six chaptersdiscussing anastomatic geometries and their effects. For example,Chapter 9 discusses the angle of an end-to-side distal anastomosisand its effects on flow patterns (Chapter 9). This discussion iscounterbalanced by the well-written chapter by the editor focusingon compliance and biomechanics in areas distant from the anasto-matic zones. The full text also provides a useful compendium oftext methodologies available for in vitro and in vivo analyses offluid dynamics and graft mechanical properties, highly useful forindividual researchers seeking such often-novel approaches forinvestigative work.

In sum, this text is highly recommended for investigatorsfocusing specifically on fluid mechanical and biomechanical prop-erties of blood vessel replacements and for those clinicians with aninterest in this important area. It is not recommended, however, asa definitive, all-inclusive discussion of either currently availablegrafts or new experimental grafts, or of the broad spectrum ofbiologic reactions to vascular grafts.

Howard P. Greisler, MD

Loyola University Health SystemsChicago, Ill

doi:10.1016/j.jvs.2003.08.001

1144 JOURNAL OF VASCULAR SURGERY/November 2003