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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



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