Symptomatic internal carotid artery dissection and kinking in a patient with fibromuscular dysplasia

Abstract

Isolated dissection of the internal carotid artery (ICA) is rare in young patients and is a cause for strong suspicion of fibromuscular dysplasia (FMD), especially when associated with artery elongation and tortuosity. The natural history of cerebrovascular FMD is unknown and management of symptomatic patients can be challenging. We report the case of a 44-year-old female patient with a history of transient ischemic attack in the absence of cardiovascular risk factors, associated with an isolated left ICA dissection and kinking. Carotid duplex ultrasound confirmed the diagnosis of dissection and demonstrated severe stenosis of the left ICA. The patient underwent surgical repair and histopathological evaluation confirmed the diagnosis of FMD with dissection. An autogenous great saphenous vein bypass was performed and the patient had an uneventful recovery. Cervical carotid artery dissection can be related to underlying arterial pathologies such as FMD, and the presence of ICA tortuosity highlights certain peculiarities for optimal management, which might be surgical.

Extracranial carotid localized fibromuscular dysplasia: A case report and literature review

“…The management and outcome of these cases differed according to the case [ Table 1 ]. [ 4 , 5 , 8 , 16 , 17 , 19 ]…”

“…Bilman et al 2021 [4] 44 We reviewed the literature for the reported cases of localized FMD involving the ICA. Only six cases consisted of localized carotid artery FMD; almost all of these cases involved the left-sided ICA.…”