Fibromuscular Dysplasia: Emerging Concepts Beyond the International Consensus

The First International Consensus on the diagnosis and management of fibromuscular dysplasia is a landmark document. Since its publication in 2019, important research has been ongoing in the field. In this review, we address current clinical challenges and discuss novel research approaches designed to overcome them. First, beyond the current distinction between multifocal and focal fibromuscular dysplasia (FMD), we propose a novel, more detailed and comprehensive classification of FMD and related diseases, which may be instrumental both as a research tool and as a common language between clinicians. Second, we discuss new information concerning phenotypes related to this condition. Third, we discuss the potential of emerging imaging and proteomic biomarkers to improve detection, diagnosis, and classification of FMD, as well as to predict prognosis and response to drugs or interventions. Finally, we describe promising novel approaches based on quantitative imaging, including computational fluid dynamics (enhanced or not by artificial intelligence), to assess the hemodynamic significance of FMD lesions. Along with further understanding of the genetics of FMD and animal models, these elements may allow for a more definite and personalized approach to this condition.