Abstract: Cerebrovascular diseases William J. Powers and Marcus E. Raichle, eds. New York, 1987, Raven Press, 396 pages, $98.00. This book contains papers and discussion from the Fifteenth Research (Princeton) Conference held in March 1986. This biennial invitational meeting brought together 75 basic and clinical specialists for a discussion of major issues in the areas of pathophysiology and treatment of cerebrovascular disease. The main topics were the biochemistry of brain ischemia, the regulation of cerebral vascular reactivity, the role of carotid endarterectomy in symptomatic patients and advances in diagnosis and treatment. The latter included updates on nuclear magnetic resonance spectroscopy, positron emission tomography, thrombolysis, and hemodilution. Of greatest interest to the vascular surgeon is the debate entitled “Should the efficacy of carotid endarterectomy in symptomatic patients be examined in a controlled clinical trial?” The affirmative was supported by Mark Dyken, who criticized past studies as inadequate, and by William Powers, who concluded that reports to date do not support the concept that advanced carotid stenosis is associated with increased risk of stroke in patients with symptoms. Jerry Goldstone and Thoralf Sundt argued the negative position, primarily on the basis of analysis of results of surgical series. Sundt emphasized the importance of studying operative risk factors in different subsets of patients. Vladimir Hachinski summarized the design of the North American Carotid Endarterectomy Trial. The general discussion by several different participants is valuable in showing the variety of perspectives concerning endarterectomy for patients with symptoms. As is the case with many books that focus on the leading edge of new work, many of the chapters soon will be superseded by newer publications as well as by subsequent Princeton Conferences. Overall, most of the book is of primary interest to neurologists; however, all physicians interested in carotid endarterectomy should read the debate on the randomized trial to obtain a fuller understanding of the wide spectrum of positions in this field.