Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia

Bolen, Michael A.; Brinza, Ellen; Renapurkar, Rahul D.; Kim, Esther S.H.; Gornik, Heather L.

doi:10.1016/j.jcmg.2016.04.010

Cited by 53 publications

(52 citation statements)

References 9 publications

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“…The true frequency of multisite FMD may be underestimated because (1) false negatives in the detection of FMD lesions by local radiologists were not sought; (2) we included patients with renal and cerebrovascular presentations and could have missed patients with signs of mesenteric or limb ischemia; and (3) we did not examine the thoracic aorta, the limb arteries, or the coronary arteries. 1,3,8,20 FMD may be revealed by spontaneous coronary artery dissection-a rare acute complication of FMD that was only described after the start of the ARCADIA registry. None of our patients reported a history of an acute coronary event.…”

Section: Discussionmentioning

confidence: 99%

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High Prevalence of Multiple Arterial Bed Lesions in Patients With Fibromuscular Dysplasia

et al. 2017

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Fibromuscular dysplasia (FMD) commonly affects the renal and cervical arteries but has been described to affect other vascular beds as well. The prevalence of and clinical characteristics associated with multisite FMD (string-of-beds or focal stenoses affecting at least 2 vascular beds) are not known. In the prospective ARCADIA registry (Assessment of Renal and Cervical Artery Dysplasia), symptomatic patients with renal artery (RA) FMD underwent tomographic- or magnetic resonance-angiography from the aortic arch to the intracranial arteries and those with cervical FMD from the diaphragm to the pelvis. Of 469 patients (84.0% women), 225 (48.0%) had multisite FMD. In addition, 86 of 244 patients with single-site disease had dissections or aneurisms affecting other vascular beds, totaling 311 patients (66.3%) with lesions in >1 vascular bed. Among patients with a cerebrovascular presentation, the prevalence of RA lesions was higher in patients with than in those without hypertension (odds ratio, 3.4; 95% confidence interval, 1.99–6.15). Among patients with a renal presentation, the prevalence of cervical lesions was higher in patients with bilateral than in those with unilateral RA lesions (odds ratio, 1.9; 95% confidence interval, 0.99–3.57). In conclusion, FMD is a systemic arterial disease. At least 2 vascular beds were affected by dysplastic stenoses in 48.0% of cases and by dysplastic stenoses, aneurysms, and dissections in 66.1% of cases. RA imaging should be proposed to hypertensive patients with a cerebrovascular presentation. Cervical artery imaging should be considered in patients with a renal presentation and bilateral RA lesions. Clinical Trial Registration— URL: www.Clinicaltrials.gov . Unique identifier: NCT02884141.

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Section: Discussionmentioning

confidence: 99%

“…We found a high prevalence of dissections and aneurysms in patients with FMD, as previously reported. 20,21 An extensive review of the ARCADIA image database will be necessary to assess their clinical relevance and document aneurysm size, site, and morphology.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Multiple Arterial Bed Lesions in Patients With Fibromuscular Dysplasia

et al. 2017

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“…The most common locations of dissection were the cerebrovascular and renal arteries [5,22]. Due to this high rate of aneurysm and dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head-to-pelvis with CTA or MRA [5,9,[23][24][25][26]. Further surveillance imaging is subsequently tailored to the patient, but in our center, carotid (CDU) is obtained with office visit every 6 months initially, followed by annual surveillance [9,21,27,28].…”

Section: Methodsmentioning

confidence: 99%

Natural History of Cervical Artery Fibromuscular Dysplasia and Associated Neurovascular Events

Kadian-Dodov¹,

Goldfinger²,

Gustavson³

et al. 2018

Cerebrovasc Dis

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Background and Purpose: Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy most often affecting the carotid and renal arteries. In the United States Registry for FMD, 41.7% of patients experienced an aneurysm and/or dissection by the time of entry into the Registry. We sought to determine the occurrence of neurovascular events after FMD diagnosis and any changes on cervical artery imaging that may be attributable to FMD. Methods: Patients followed at the Mount Sinai Medical Center (US Registry for FMD enrollment center) with confirmed FMD and > 1 cervical artery imaging study (at least ± 6 months from the baseline carotid duplex ultrasound [CDU]) between the years 2003 and 2015 were included. Medical records and cervical artery imaging ([CDU], magnetic resonance angiogram [MRA], and computed tomography angiogram [CTA]) were reviewed. New arterial dissection, aneurysm, transient ischemic attack, stroke, or new FMD findings were recorded. Results: Among 146 FMD patients with complete information, 52 (35.6%) had an aneurysm and 52 (35.6%) had a dissection. Mean clinical follow-up was 35.3 ± 25.3 months (range 5–153 months); patients underwent 4 ± 2.7 CDU (range 1–17); 86.3% had ≥1 neck MRA or CTA. After FMD diagnosis, 3 patients (2%) experienced a new carotid artery dissection; 1 patient experienced a stroke due to concomitant atherosclerosis. No new aneurysms occurred. In patients with cervical artery FMD, imaging findings remained stable throughout follow-up. No patient developed new cervical artery FMD findings on follow-up imaging. Conclusions: No new cervical artery FMD or aneurysm was observed on subsequent imaging. New carotid dissection was uncommon over a mean follow-up period of 35.3 ± 25.3 months and was the only non-atherosclerotic vascular event observed after FMD diagnosis.

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“…Multiple reconstruction formats, including multiplanar reformatted images, shaded surface display, and maximum-intensity projections, are necessary to adequately review for changes of FMD. 70,269 For the detection of brain aneurysms, multirow detector computed tomography angiography is generally the preferred noninvasive imaging method because it provides detailed evaluation of the extracranial carotid, vertebral, and intracranial arteries for potential aneurysms. 70,270,271 The sensitivity for aneurysms <3 mm is 82%.…”

Section: Diagnosis Of Scad-associated Extracoronary Arteriopathiesmentioning

confidence: 99%

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

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Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

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Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia

Abstract: Screening chest, abdomen, and pelvis CTA in patients with FMD showed substantial and incremental diagnostic yield. Reformatted images should routinely be included in imaging analysis. Abnormalities in the aorta were not common, so screening of the thoracic aorta may not be indicated.

Cited by 53 publications

References 9 publications

High Prevalence of Multiple Arterial Bed Lesions in Patients With Fibromuscular Dysplasia

High Prevalence of Multiple Arterial Bed Lesions in Patients With Fibromuscular Dysplasia

Natural History of Cervical Artery Fibromuscular Dysplasia and Associated Neurovascular Events

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

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