Fibromuscular hyperplasia and stationary waves of the internal carotid artery

Fibromuscular dysplasia and the brain. II. Current concept of the disease

Eleven hundred cases from the literature of fibromuscular dysplasia (FMD) are reviewed including 300 cases with aortocranial lesions. The male-female ratio is 1:2, and the prevalence seems increased among Caucasians. The clinical diagnosis of FMD is made by angiography, ten years earlier in patients with hypertension (mean age 39 years) than in those with cerebrovascular symptoms (mean age 50 years). Segmental dysplastic lesions are found mainly in primary aortic branches. All age groups may be affected and follow-up studies give evidence for stationary as well as slowly progressive lesions. A multifactorial hypothesis of etiology is presented: congenital minor lesions of tunica medial might predispose to aneurysms and to an abnormal fibroproliferative response to mechanical or circulatory stimuli. The association of FMD and intracranial aneurysmal disease in females is discussed. Inheritance as a dominant trait with reduced penetrance in males is suspected. Current aspects on morphology, symptomatology and clinical management are presented.

Fibromuscular disease of carotid arteries: long term results of graduated internal dilatation

From 1967 to 1979, 25 patients (pts) were operated on for fibromuscular disease (FMD) of the internal carotid artery (ICA). Eleven patients (44%) had transient weakness of an extremity, 4 had amaurosis fugax and 6 (24%) had an asymptomatic carotid bruit. Bilateral carotid arteriography showed significant stenotic lesions in 23 pts (92%) (bilateral in 10), arterial dissection in 1, and severe associated atherosclerosis with ICA endarterectomy and graduated internal dilatation (GID) (9 bilateral); 2 underwent GID with ICA endarterectomy and patch graft: 1 pt had tube graft replacement of the ICA. There was no operative mortality. One pt had a stroke during operation after tube graft replacement of the ICA. Of the 19 pts followed for 2 to 12 years (mean 7.3 years), 2 had late recurrence of mild symptoms. One pt required GID of the contralateral ICA recurrence of symptoms 4 years postoperatively. Graduated internal dilatation of fibromuscular disease of the internal carotid artery can produce long term relief of symptoms; recurrence is rare.

Angiographic spectrum of cervical and intracranial fibromuscular dysplasia

Cephalocervical or intracranial fibromuscular dysplasia (FMD) can be identified by its characteristic angiographic appearance. Most of these lesions occur adjacent to the C1-2 interspace, characteristically sparing the origins and proximal segments of the major extracranial vessels. Approximately 65% of our patients had bilateral involvement of the cervical internal carotid arteries. Thirty percent were associated with one or more intracranial aneurysms. The vertebral arteries were involved in 10% of the cases. Twenty-four of 25 cases were associated with symptoms of either subarachnoid hemorrhage or focal cerebral ischemia.

Intracranial fibromuscular dysplasia: report of two cases, one with autopsy verification

We report two patients with fibromuscular dysplasia (FMD) involving intracranial arteries. In the first patient the diagnosis was made at autopsy. Both patients were symptomatic from this disease and, in addition, displayed unusual hormonal abnormalities which may well have contributed to the genesis or evolution of FMD.

[Fibro-muscular dysplasia of the cerebral vessels. Report of 7 cases]

Os autores apresentam sete casos de displasia fibro-muscular (DFM), sendo seis deles na artéria carótida e um na artéria vertebral, estudados pelas correspondentes angiografias. São relatadas as histórias clínicas que, em cinco pacientes, são de acidente vascular cerebral isquêmico e, em dois, de hemorragia sub-aracnóide por rotura de aneurisma. Dois pacientes foram à cirurgia: um deles sofreu ligadura de carótida primitiva e outro sofreu endarterectomia para retirada de placa de ateroma da artéria carótida contralateral a aquela com DFM. Finalmente é feita breve discussão sobre a referida patologia, quadro clínico, dignóstico e tratamento, sendo ressaltada a importância do estudo angiográfico carotídeo e vertebral quando encontrada DFM em outro território vascular.