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Doody's Review ServiceReviewer: John F. Moran, MD (Loyola University Stritch School of Medicine)
Description: This text is another in the American Heart Association Monograph Series. It is the result of a meeting of the Committee of the American Heart Association Council on Atherosclerosis which occurs about every two years. It is a multi-authored text that features experts in pathology, imaging, and clinical and vascular biology.
Purpose: The purpose is to provide a multi-disciplinary approach to studying atherosclerosis, which will lead to a better understanding of the disease process. The committee hopes to make a statement every two years or so and disseminate the available knowledge and insight into atherosclerosis.
Audience: This text is an excellent review of the subject that will be of value to researchers and graduate student as well as cardiovascular practitioners and trainees in cardiology.
Features: The text begins with a description of the vulnerable plaque and the interaction it has with acute thrombus. Coronary angiography can identify significant plaque formation but does not identify the plaque more likely to occlude. In fact, several studies now show that two-thirds of coronary artery occlusions occur in areas where the plaque obstruction was less than 50%. This book contains current chapters on intravascular ultrasound, angioscopy, ultrafast computerized tomography, magnetic resonance imaging, and thermography. These imaging techniques are all attempts to identify the plaque most likely to occlude the artery. The text is grouped into six sections with up to seven chapters in each section. Each section is followed by a panel discussion involving the contributors as well as members of the audience. This is quite helpful. The shortcomings of this text are basically the shortcomings of our insight into atherosclerosis.
Assessment: There are four insightful chapters on the mechanics of plaque disruption. The final three chapters take up some of the present and future directions of research in this area. Currently our management of these patients should involve antithrombotic aspirin and the cholesterol-lowering 'statin' drugs. However, the future management of atherosclerotic plaque from description to detection to treatment looks very promising. This book is a welcome contribution to the field.