Page 301 - Read Online
P. 301
genetic predisposition, hormonal factors, and arterial adverse events and complications were observed
wall ischemia. [1,4] The pathogenesis of FMD remains suggesting that angioplasty with stenting may
unclear. A number of theories have been proposed, be a safe and effective treatment method for this
including the environmental factors such as smoking condition.
and estrogen, as well as genetic factors; however, about
10% of patients with FMD have an affected family Financial support and sponsorship
member. [5] This study was supported by the National Natural
Science Foundation of China (Grant No. 81471195) and
cFMD may be asymptomatic or associated with a the second affiliated hospital of Soochow university
variety of nonspecific symptoms, including headache, preponderant clinic discipline group project funding
tinnitus, vertigo, lightheadedness, and syncope. (Grant No. XKQ2015002).
[1]
The clinical manifestations of cFMD are variable
and depend on a number of factors, including the Conflicts of interest
distribution of vascular bed involvement and the There are no conflicts of interest.
type and severity of the vascular lesions. [6,7] The more
specific neurologic syndromes of TIA, amaurosis REFERENCES
fugax, stroke, Horner’s syndrome, and cranial‑nerve 1. Slovut DP, Olin JW. Fibromuscular dysplasia. N Engl J Med
palsies may be the first presentation of FMD involving 2004;350:1862‑71.
[8]
the carotid or VA. And the most feared and serious 2. Plouin PF, Perdu J, La Batide‑Alanore A, Boutouyrie P,
sequela of cFMD include TIA, stroke, subarachnoid Gimenez‑Roqueplo AP, Jeunemaitre X. Fibromuscular dysplasia.
hemorrhage, and cervical artery dissection. It shows 3. Orphanet J Rare Dis 2007;2:28.
Shejul YK, Viswanathan MK, Jangale P, Kulkarni A. Fibromuscular
that FMD is present in about 15‑20% of patients with dysplasia: a cause of secondary hypertension. Korean J Intern Med
[9]
a spontaneous dissection of carotid or VA. And 2014;29:840‑1.
multiple cervical artery dissections are more common 4. Mettinger KL. Fibromuscular dysplasia and the brain. II. Current
in patients with an underlying arteriopathy, such as 5. concept of the disease. Stroke 1982;13:53‑8.
Poloskey SL, Olin JW, Mace P, Gornik HL. Fibromuscular dysplasia.
FMD. [10] Circulation 2012;125:e636‑9.
6. Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH,
Noninvasive imaging modalities for diagnosing FMD Jaff MR, Kim ES, Mace P, Matsumoto AH, McBane RD,
include Doppler ultrasound, computed tomographic Kline‑Rogers E, White CJ, Gornik HL. The United States Registry for
angiography, and magnetic resonance angiography. Fibromuscular Dysplasia: results in the first 447 patients. Circulation
2012;125:3182‑90.
The accepted gold standard for the diagnosis of cFMD 7. Sharma AM, Kline B. The United States registry for fibromuscular
is DSA. “String of beads pattern” in the pathological dysplasia: new findings and breaking myths. Tech Vasc Interv Radiol
carotid or renal arteries is an important and most 2014;17:258‑63.
common angiographic finding and is present in 8. Mettinger KL, Ericson K. Fibromuscular dysplasia and the brain. I.
Observations on angiographic, clinical and genetic characteristics.
over 90% of cases. However, it was not observed Stroke 1982;13:46‑52.
in this present case. This invasive test should be 9. Divjak I, Slankamenac P, Jovicevic M, Zikic TR, Jesic A. Diagnosis
considered for those symptomatic patients in whom and outcome of cervical artery dissection. Med Pregl 2011;64:392‑6.
intervention is contemplated or for cases in which 10. Bejot Y, Aboa‑Eboule C, Debette S, Pezzini A, Tatlisumak T,
Engelter S, Grond‑Ginsbach C, Touze E, Sessa M, Metso T, Metso A,
there is uncertainty about the patient’s diagnosis or Kloss M, Caso V, Dallongeville J, Lyrer P, Leys D, Giroud M,
severity of the disease. [11] Pandolfo M, Abboud S’CADISP Group. Characteristics and
outcomes of patients with multiple cervical artery dissection. Stroke
2014;45:37‑41.
Medical therapy and revascularization are the two major 11. Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH,
treatment options for cFMD patients. As previously Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA,
discussed, antiplatelet therapy is the mainstay of the Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC,
medical therapy. For symptomatic patients with carotid American Heart Association Council on Peripheral Vascular Disease;
or vertebral artery FMD, who have suffered a dissection, American Heart Association Council on Clinical Cardiology;
American Heart Association Council on Cardiopulmonary; Critical
angioplasty with stenting may be performed. The Care, Perioperative and Resuscitation; American Heart Association
indications for intervening in cFMD are for those Council on Cardiovascular Disease in the Young; American Heart
in whom antiplatelet or anticoagulant therapy is Association Council on Cardiovascular Radiology and Intervention;
contraindicated or less effective and for those cFMD American Heart Association Council on Epidemiology and
Prevention, American Heart Association Council on Functional
patients with pseudoaneurysm formation, usually the Genomics and Translational Biology; American Heart Association
result of a prior dissection. [12] Council for High Blood Pressure Research; American Heart
Association Council on the Kidney in Cardiovascular Disease;
American Heart Association Stroke Council. Fibromuscular
The patient was successfully treated with angioplasty dysplasia: state of the science and critical unanswered questions: a
with stenting. During the follow‑up period, no scientific statement from the American Heart Association. Circulation
292 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015 293