Cerebrovascular complications of fibromuscular dysplasia

Extracranial carotid localized fibromuscular dysplasia: A case report and literature review

Background:

Fibromuscular dysplasia (FMD) is a noninflammatory and nonatherosclerotic arteriopathy that is characterized by irregular cellular proliferation and deformed construction of the arterial wall that causes segmentation, constriction, or aneurysm in the intermediate-sized arteries. The incidence of FMD is 0.42–3.4%, and the unilateral occurrence is even rarer. Herein, we report a rare case of a localized extracranial carotid unilateral FMD associated with recurrent transient ischemic attacks (TIAs) treated by extracranial-intracranial bypass for indirect revascularization. The specific localization of the disease rendered our case unique.

Methods:

We conducted a review of the PubMed Medline database search using the following combined formula: ((FMD [Title/Abstract]) AND ((isolated [Title/Abstract]) OR (localized [Title/Abstract]))) AND Internal carotid artery (ICA) (Title/Abstract). Additional resources were included by screening the reference list of the selected papers.

Results:

A total of six cases were found, and all accounted for localized FMD affecting the ICA. The age range was between 19 and 52, the male-to-female ratio was (2:4), and all of the cases consisted of unilateral carotid FMD, mainly on the left side with a left-to-right ratio of 5:1. The management and outcome of these cases varied according to the case and associated complications.

Conclusion:

Extracranial localized FMD of the ICA is a rare subtype of FMD that has little documentation in the literature. In our case, it was a localized extracranial carotid unilateral FMD associated with recurrent TIAs. The appropriate treatment was using the intracranial-extracranial bypass.

Carotid Artery Stenting for Carotid Arterial Fibromuscular Dysplasia Evaluated Vascular Wall Structure Using Optical Coherence Tomography: A Case Report

Objective

Fibromuscular dysplasia (FMD) is often diagnosed based on angiography. However, it is difficult to distinguish from vasculitis by angiography. Therefore, it is important to evaluate the detailed intravascular findings of lesions in FMD using optical coherence tomography (OCT).

Case Presentation

We present a case of a 30-year-old woman with left carotid artery stenosis. The lesion was diagnosed with a suspected case of FMD by MRA, and gradually progressed over the course of 7 years. Therefore, we underwent carotid artery stenting (CAS) using OCT, and good dilatation of the lesion was obtained.

Conclusion

OCT evaluation during CAS allowed for a definitive diagnosis of FMD because the OCT images revealed a detailed finding of the three layers of the carotid artery.

Fibromuscular dysplasia

The most common clinical manifestations of fibromuscular dysplasia (FMD) are hypertension due to renal artery involvement and transient ischemic attack or stroke due to carotid or vertebral artery involvement. Patients with renal artery FMD and hypertension should undergo primary angioplasty with the goal of curing the hypertension. If the blood pressure fails to normalize following angioplasty, the physician should institute antihypertensive medications according to the recommendations of the Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure VII. In patients with cerebrovascular FMD, antiplatelet agents represent the cornerstone of therapy. Percutaneous angioplasty has emerged as the preferred treatment for symptomatic cerebrovascular FMD.