How is fibromuscular dysplasia (FMD) treated?

Updated: Jul 27, 2018
  • Author: James A Wilson, MD, MSc, FRCPC; Chief Editor: Helmi L Lutsep, MD  more...
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Partly because of the unknown etiology of FMD, no curative therapy exists. Fortunately, FMD is often benign when asymptomatic, and medical treatment is not indicated. In symptomatic cases, management depends on the presentation, as follows:

  • Presentation with hypertension: The patient should be evaluated by a nephrologist and possibly considered for vascular intervention

  • Presentation as a TIA or ischemic stroke: If the patient presents within 3 hours of onset, consider intravenous tissue plasminogen activator (tPA); intra-arterial mechanical embolectomy and intra-arterial pharmacologic fibrinolysis may be considered to extend the acute treatment window to 6 hours; if tPA treatment is employed, avoid anticoagulants and antiplatelet agents for at least 24 hours

  • The diagnosis of FMD should be considered in any young individual presenting with a stroke or subarachnoid hemorrhage. Fortunately, cerebral angiography is the investigation of choice to detect not only FMD but also arterial dissection, vasculitis, and aneurysms, which are other major etiologies of stroke in this population. Thus, cerebral angiography should be performed if another cause for the stroke is not clear. The treatment options are influenced by the findings on angiography

  • Presentation with only FMD identified on angiography: Administer antiplatelet agents

  • Presentation with arterial dissection and FMD identified on cerebral angiography: Initially, focus on the dissection; consider anticoagulation after cerebral hemorrhage has been ruled out

  • Presentation with subarachnoid hemorrhage: Focus acute treatment on preventing rebleeding, arterial vasospasm, and further ischemic cerebral injury; close aneurysms; subsequently, manage conservatively unless further history is consistent with thromboembolic phenomena

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