Stroke Treatment and Prevention: An Evidence-Based Approach

doi:10.3174/ajnr.A0579

G.J. Hankey, ed. New York: Cambridge University Press; 2005. 536 pages, $140.

In his preface, Hankey writes that the aim of his book is, “to provide stroke clinicians (and their patients and families), with ready access to the optimal evidence to guide best practice in acute stroke treatment and (secondary) prevention of recurrent serious vascular events.” It is, in my experience, rare that a book so completely meets the author’s stated aim as does this immensely informative text. In 400 pages of text and more than 100 pages of references, Hankey provides us with detailed reviews and personal assessments of available literature related to most conditions related to both hemorrhagic and ischemic strokes. As a bonus, there are also excellent chapters dealing with understanding evidence, organizing acute stroke care, and general supportive acute stroke care.

In 14 chapters organized according to either the major causes of stroke or to therapeutic and preventive issues arising either because of a stroke or with the aim of preventing a stroke, Hankey has compiled a comprehensive data base of available literature. He then provides and analyzes in a meticulous fashion the available evidence and its quality while also providing, in most cases, Forest plots of the reported studies. For the reader, this greatly simplifies a comparison of the reported results. Along with these clearly presented facts, he then adds his interpretation of the data, as well as a view on their implication for clinical practice. The unusual combination of an inclusive literature review with an analysis by someone with, “clinical experience, acumen and common sense” (from his preface) is rare.

This is not a book for the bedside table; it is packed with facts that, while clearly presented, require concentration and contemplation for full understanding and application. It is a book that should be available in the “trenches” wherever acute stroke diagnosis and care are provided. I would suspect that its value to students and house officers will be clearly demonstrated by the number of copies that mysteriously disappear from departmental libraries, finding their way into on-call rooms and other haunts regularly occupied by those having first-line responsibility for making decisions about the diagnosis and treatment of stroke. No matter what their level of training or experience, this book will be useful to anyone interested in the topic of stroke.

The only meaningful criticism of this book, as recognized by Hankey, is that it will over a relatively short time become dated. It will remain, however, an extremely useful source as long as it is available.