Recognizing and managing fibromuscular dysplasia
Jeffrey W. Olin, DO
Professor of Medicine (Cardiology), Director, Vascular Medicine, The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York
Address: Jeffrey W. Olin, DO, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1033, New York, NY 10029; e-mail: firstname.lastname@example.org
Medical Grand Rounds articles are based on edited transcripts from Division of Medicine Grand Rounds presentations at The Cleveland Clinic. They are approved by the author but are not peer-reviewed.
ABSTRACTFibromuscular dysplasia typically occurs in young women and most commonly presents with hypertension, transient ischemic attack, stroke, or an asymptomatic cervical bruit. The disease is nonatherosclerotic and noninflammatory and most often affects the renal and carotid arteries, although almost any artery can be involved. On angiography, affected blood vessels characteristically resemble a string of beads in the most common type of fibromuscular dysplasia, medial fibroplasia. Patients with renal artery stenosis and hypertension or renal impairment should be treated with percutaneous transluminal angioplasty without a stent. Patients with fibromuscular dysplasia of the internal carotid artery should also be treated with angioplasty if they develop focal neurologic symptoms such as a transient ischemic attack or stroke.