Invasive treatment for carotid fibromuscular dysplasia

Tekieli, Łukasz; Maciejewski, Damian; Dzierwa, Karolina; Kabłak‐Ziembicka, Anna; Michalski, Michał; Wójcik-Pędziwiatr, Magdalena; Brzychczy, Andrzej; Moczulski, Zbigniew; Żmudka, Krzysztof; Pienia̦żek, Piotr

doi:10.5114/pwki.2015.52285

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Percutaneous transluminal balloon angioplasty (PTA) is the first line of treatment for those with symptomatic extracranial cerebral vascular FMD. Endovascular and surgical therapy with stents or coils is reserved for patients with aneurysms [9]. In renal artery FMD, the main goal is strict blood pressure control to prevent sequelae of long-standing poorly controlled HTN.…”

Section: Discussionmentioning

confidence: 99%

Carotid Webs: An Unusual Presentation of Fibromuscular Dysplasia

Priyadarshni¹,

Neralla²,

Reimon³

et al. 2020

Cureus

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Carotid webs are abnormal luminal projections at the carotid bulb associated with blood flow stasis, artery dissection, and subsequent complications. Carotid webs are considered to be a rare variant of fibromuscular dysplasia (FMD). Young individuals with symptomatic carotid webs are found to be associated with ischemic stroke. The incidence of the carotid web is low, and it is rarely reported. Only 150 cases of FMD have been reported so far. FMD is a noninflammatory and non-atherosclerotic arteriopathy. The most common arterial beds involved are renal and extracranial carotids. Presentation varies depending on the location of the arterial bed involved and disease severity. Clinical presentations range from minor headaches to severe headaches, resistant hypertension, acute coronary syndrome, transient ischemic attack, and in some cases, stroke. Diagnosis can be made through non-invasive methods, such as computed tomographic angiography, magnetic resonance angiography, or duplex ultrasonography or invasive imaging methods like catheter-based angiography. Treatment of FMD varies with disease presentation and its location. Asymptomatic carotid or vertebral arteries FMD should be monitored clinically and prescribed aspirin 81 mg daily for primary stroke prevention. Endovascular and surgical therapy with stents or coils is reserved for patients with aneurysms. We present a rare and interesting case of a 54-year-old female who presented with acute ischemic stroke in the setting of right carotid artery web, right internal carotid artery (ICA) thrombus with dissection, and possible pseudoaneurysm.

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Section: Discussionmentioning

confidence: 99%

Carotid Webs: An Unusual Presentation of Fibromuscular Dysplasia

Priyadarshni¹,

Neralla²,

Reimon³

et al. 2020

Cureus

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“…FMD was recognized when beaded multifocal (string-of-beads) and focal/tubular lesions other than plaques in medium-sized arteries were displayed [ 30 ]. Arterial dissection and/or an aneurysm localized in a medium-sized artery was considered FMD if a patient had a focal or multifocal lesion(s) in another/other vascular bed(s) ( Figure 2 ).…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature

et al. 2023

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Non-atherosclerotic aortic arch pathologies (NA-AAPs) and anatomical variants are characterized as rare cardiovascular diseases with a low incidence rate, below 1 case per 2000 population, but enormous heterogeneity in terms of anatomical variants, i.e., Takayasu disease (TAK) and fibromuscular dysplasia (FMD). In specific clinical scenarios, NA-AAPs constitute life-threatening disorders. Methods: In this study, 82 (1.07%) consecutive patients with NA-AAPs (including 38 TAKs, 26 FMDs, and 18 other AAPs) out of 7645 patients who underwent endovascular treatment (EVT) for the aortic arch and its side-branch diseases at a single institution between 2002 and 2022 were retrospectively reviewed. The recorded demographic, biochemical, diagnostic, operative, and postoperative factors were reviewed, and the functional outcomes were determined during follow-up. A systematic review of the literature was also performed. Results: The study group comprised 65 (79.3%) female and 17 (21.7%) male subjects with a mean age of 46.1 ± 14.9 years. Overall, 62 (75.6%) patients were diagnosed with either cerebral ischemia symptoms or aortic arch dissection on admission. The EVT was feasible in 59 (72%) patients, whereas 23 (28%) patients were referred for medical treatment. In EVT patients, severe periprocedural complications occurred in two (3.39%) patients, including one periprocedural death and one cerebral hyperperfusion syndrome. During a median follow-up period of 64 months, cardiovascular events occurred in 24 (29.6%) patients (5 deaths, 13 ISs, and 6 myocardial infarctions). Repeated EVT for the index lesion was performed in 21/59 (35.6%) patients, including 19/33 (57.6%) in TAK and 2/13 (15.4%) in FMD. In the AAP group, one patient required additional stent-graft implantation for progressing dissection to the iliac arteries at 12 months. A baseline white blood count (odds ratio [HR]: 1.25, 95% confidence interval [CI]: 1.11–1.39; p < 0.001) was the only independent prognostic factor for recurrent stenosis, while a baseline hemoglobin level (HR: 0.73, 95%CI: 0.59–0.89; p = 0.002) and coronary involvement (HR: 4.11, 95%CI: 1.74–9.71; p = 0.001) were independently associated with a risk of major cardiac and cerebral events according to the multivariate Cox proportional hazards regression analysis. Conclusions: This study showed that AAPs should not be neglected in clinical settings, as it can be a life-threatening condition requiring a multidisciplinary approach. The knowledge of prognostic risk factors for adverse outcomes may improve surveillance in this group of patients.

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“…25 Because of pathologic underlying arterial architecture, the high risk of dissection and residual stenosis from angioplasty alone can necessitate stenting. 26 Advances in medical management during the last 3½ decades have greatly improved the prognosis of patients with atherosclerotic carotid disease. The average annual ipsilateral stroke rate in asymptomatic patients with advanced disease has decreased by more than 67%, corresponding with advances in diagnosis and modification of arterial disease risk factors.…”

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confidence: 99%