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Updated: Aug 14, 2025
Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases
Published on: December 6, 2016
A Retrospective Cohort Study of Cerebrovascular Fibromuscular Dysplasia
Anthousa Kythreotou1, Ruwan A Weerakkody2, Kantida Koysombat1
1Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK.
Insights
Fibromuscular dysplasia (FMD) is a rare condition affecting blood vessels, predominantly in women. This study highlights that carotid FMD often involves multiple sites and can lead to extracerebral complications, suggesting a hereditary component.
Area of Science:
- Vascular Medicine
- Radiology
- Genetics
Background:
- Fibromuscular dysplasia (FMD) is a rare vasculopathy with limited European data.
- This study investigates the clinical characteristics and outcomes of carotid FMD in a regional cohort.
Purpose of the Study:
- To assess the clinical features of carotid FMD patients.
- To evaluate the vascular complication rates in this population.
- To identify potential hereditary links in FMD.
Main Methods:
- Retrospective cohort study of cerebrovascular FMD cases (1998-2020).
- Screening of imaging reports and patient notes using keywords: FMD, Fibromuscular Dysplasia, carotid.
- Extraction of clinical data and recording of vascular disease extent.
Main Results:
- Eighty-six patients identified; mean age 64, 90% female, 75% Caucasian.
- Stroke/TIA (63%) was the most common presentation; 41% experienced cerebrovascular complications.
- High rates of multisite involvement (80%) and hereditary factors (7% family history, 9% connective tissue disorders) were observed.
Conclusions:
- Carotid FMD frequently involves multiple vessels and sites.
- Extracerebral vascular complications and hereditary vasculopathy are significant findings.
- Careful screening and surveillance are crucial for managing carotid FMD patients.
Background:
Fibromuscular dysplasia (FMD) is a rare vasculopathy for which limited data are available particularly from Europe. Our aim was to study the clinical characteristics of a regional cohort of carotid fibromuscular dysplasia patients to assess their clinical outcomes and the rate of vascular complications.
Methods:
A retrospective cohort study of all cases of carotid/cerebrovascular FMD presenting to our regional vascular service (catchment population approximately 2 million), between 1998 and 2020. Imaging reports and patient case notes were screened using the keywords "FMD", "Fibromuscular Dysplasia", and "carotid". From case-note and imaging review, all relevant clinical data were extracted and the anatomical extent of vascular disease recorded.
Results:
Eighty six patients with a diagnosis of cerebrovascular fibromuscular dysplasia were identified on imaging (31 computed tomography angiography, 46 magnetic resonance angiography, and 9 digital subtraction angiography) by a neurovascular radiologist. The mean age was 64 years, 78 (90%) patients were female, and 45/59 (75%) were Caucasian. Presenting clinical syndromes were Stroke/transient ischemic attack in 54 (63%) patients, symptomatic intracranial aneurysm in 6 (10%), and other neurological symptoms (headache/migraine, tinnitus) in 14 (16%), with 11 (13%) presenting incidentally. Six patients (7%) had a positive family history of FMD (2 patients) or other cerebrovascular event (4 patients: carotid dissection, intracerebral bleed, or stroke). Eight patients (9%) had a known or suspected hereditary connective tissue disorder (2 Ehlers-Danlos syndrome). Involved vessels were as follows: Carotid (mainly extracranial) in 79 (92%), vertebral 19 (22%), and a combination of these in 15 (17%) patients. Fifty eight (67%) patients had bilateral disease. Cerebrovascular complications were observed in 35 (41%) patients as follows: carotid dissection 11 (23%), carotid stenosis or occlusion 8 (9%), carotid aneurysm 8 (9%), cerebral aneurysm 9 (11%), vertebral aneurysm/dissection 2 (2%), and carotid-cavernous fistula 2 (2%). Of the 22 patients who had extracranial imaging, 14 (60%) had FMD affecting other beds-renal artery in 8 (36%) patients, other visceral arteries in 4 (18%), and aorta in 2 (9%). In addition, 4 (18%) patients had aneurysm or dissection affecting renal, splenic, and lower limb arteries. Overall, 67 (80%) patients had FMD affecting more than 1 vessel and 50 (58%) had multisite FMD (>/ = 2 vascular beds involved). Fifty nine (68%) patients were managed conservatively on close surveillance. Nineteen (21%) patients required carotid/cerebrovascular intervention and 9 (10%) required vascular intervention at other sites. Recurrent cerebrovascular events (stroke/transient ischemic attack, symptomatic Berry aneurysm) were seen in 20 (23%) patients. Overall mortality was 7% over a median follow-up period of 47 months.
Conclusions:
Carotid FMD patients have a high rate of multisite involvement, extracerebral vascular complications, and evidence of hereditary vasculopathy, requiring careful screening and surveillance.
