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Invasive treatment for carotid fibromuscular dysplasia.

Tekieli ŁM, Maciejewski DR, Dzierwa K, Kabłak-Ziembicka A, Michalski M, Wójcik-Pędziwiatr M, Brzychczy A, Moczulski Z, Żmudka K, Pieniążek P - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: If the result of balloon angioplasty was not satisfactory (> 30% residual stenosis, dissection), stent placement was scheduled.The FMD group was younger (47.9 ±7.5 years vs. 67.2 ±8.9 years, p = 0.0001), with higher prevalence of women (71.4% vs. 32.7%, p = 0.0422), a higher rate of dissected lesions (57.1% vs. 4.6%, p = 0.0002) and less severe stenosis (73.4% vs. 83.9%, p = 0.0070) as compared to the non-FMD group.Fibromuscular dysplasia is rare among patients referred for CAS.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

ABSTRACT

Introduction: Fibromuscular dysplasia (FMD) is an infrequent non-inflamatory disease of unknown etiology that affects mainly medium-size arteries. The prevalence of FMD among patients scheduled for endovascular treatment of carotid artery stenosis is unknown.

Aim: To evaluate the prevalence and treatment options of carotid FMD in patients scheduled for carotid artery stenting (CAS).

Material and methods: Between Jan 2001 and Dec 2013, 2012 CAS procedures were performed in 1809 patients (66.1% men; age 65.3 ±8.4 years, 49.2% symptomatic). In case of FMD suspicion in Doppler-duplex ultrasound (DUS), computed tomography angiography was performed for aortic arch and extracranial and intracranial artery imaging. For invasive treatment of FMD carotid stenosis, balloon angioplasty was considered first. If the result of balloon angioplasty was not satisfactory (> 30% residual stenosis, dissection), stent placement was scheduled. All patients underwent follow-up DUS and neurological examination 3, 6 and 12 months after angioplasty, then annually.

Results: There were 7 (0.4%) (4 symptomatic) cases of FMD. The FMD group was younger (47.9 ±7.5 years vs. 67.2 ±8.9 years, p = 0.0001), with higher prevalence of women (71.4% vs. 32.7%, p = 0.0422), a higher rate of dissected lesions (57.1% vs. 4.6%, p = 0.0002) and less severe stenosis (73.4% vs. 83.9%, p = 0.0070) as compared to the non-FMD group. In the non-FMD group the prevalence of coronary artery disease was higher (65.1% vs. 14.3% in FMD group, p = 0.009). All FMD patients underwent successful carotid artery angioplasty with the use of neuroprotection devices. In 4 cases angioplasty was supported by stent implantation.

Conclusions: Fibromuscular dysplasia is rare among patients referred for CAS. In case of significant FMD carotid stenosis, it may be treated with balloon angioplasty (stent supported if necessary) with optimal immediate and long-term results.

No MeSH data available.


Related in: MedlinePlus

A 63-year-old female patient with hypertension and history of ST elevation anterior myocardial infarction presented with bilateral, asymptomatic ICA stenosis. A, B – CT angiography. A – 3D aortic arch reconstruction. B – vertical section of proximal RICA showing focal critical artery narrowing (arrow). C, D, E – catheter angiography. C – significant RICA stenosis caused by FMD. D – angioplasty with 4.0 × 20 mm balloon with a distal neuroprotection system. E – optimal immediate result of balloon angioplasty, no need for stent implantation
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Figure 0002: A 63-year-old female patient with hypertension and history of ST elevation anterior myocardial infarction presented with bilateral, asymptomatic ICA stenosis. A, B – CT angiography. A – 3D aortic arch reconstruction. B – vertical section of proximal RICA showing focal critical artery narrowing (arrow). C, D, E – catheter angiography. C – significant RICA stenosis caused by FMD. D – angioplasty with 4.0 × 20 mm balloon with a distal neuroprotection system. E – optimal immediate result of balloon angioplasty, no need for stent implantation

Mentions: Patient 2: A 63-year-old female patient with hypertension and a history of ST elevation anterior myocardial infarction (MI) presented with asymptomatic bilateral carotid bruit and CCS 3 angina for further non-invasive and invasive evaluation. Admission DUS showed bilateral ICA stenosis with peak systolic velocity/end diastolic velocity (PSV/EDV) of 1.5/0.6 m/s on the left side and PSV/EDV of 3.1/1.3 m/s on the right side (> 80% stenosis according to the Bluth criteria). Interestingly, 6 months earlier RICA PSV/EDV were 1.9/0.9 m/s. Figure 2A and B show CTA images of RICA. Despite the asymptomatic status, the multidisciplinary team members decided to qualify the patient for carotid artery angioplasty due to severe disease progression revealed in DUS. Coronarography revealed no coronary artery disease. Angiography confirmed significant RICA stenosis caused by FMD (Figure 2C). With distal neuroprotection (FilterWire EZ, Boston Scientific, Natick, MA, USA), angioplasty with a 4.0 × 20 mm balloon was performed (Figure 2D). The immediate result was optimal, and no stent implantation was required (Figure 2E). The periprocedural and postprocedural period was uneventful. For the next 36 months of follow-up the patient has remained neurologically asymptomatic with a preserved RICA angioplasty effect and stable LICA image in DUS.


Invasive treatment for carotid fibromuscular dysplasia.

Tekieli ŁM, Maciejewski DR, Dzierwa K, Kabłak-Ziembicka A, Michalski M, Wójcik-Pędziwiatr M, Brzychczy A, Moczulski Z, Żmudka K, Pieniążek P - Postepy Kardiol Interwencyjnej (2015)

A 63-year-old female patient with hypertension and history of ST elevation anterior myocardial infarction presented with bilateral, asymptomatic ICA stenosis. A, B – CT angiography. A – 3D aortic arch reconstruction. B – vertical section of proximal RICA showing focal critical artery narrowing (arrow). C, D, E – catheter angiography. C – significant RICA stenosis caused by FMD. D – angioplasty with 4.0 × 20 mm balloon with a distal neuroprotection system. E – optimal immediate result of balloon angioplasty, no need for stent implantation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495128&req=5

Figure 0002: A 63-year-old female patient with hypertension and history of ST elevation anterior myocardial infarction presented with bilateral, asymptomatic ICA stenosis. A, B – CT angiography. A – 3D aortic arch reconstruction. B – vertical section of proximal RICA showing focal critical artery narrowing (arrow). C, D, E – catheter angiography. C – significant RICA stenosis caused by FMD. D – angioplasty with 4.0 × 20 mm balloon with a distal neuroprotection system. E – optimal immediate result of balloon angioplasty, no need for stent implantation
Mentions: Patient 2: A 63-year-old female patient with hypertension and a history of ST elevation anterior myocardial infarction (MI) presented with asymptomatic bilateral carotid bruit and CCS 3 angina for further non-invasive and invasive evaluation. Admission DUS showed bilateral ICA stenosis with peak systolic velocity/end diastolic velocity (PSV/EDV) of 1.5/0.6 m/s on the left side and PSV/EDV of 3.1/1.3 m/s on the right side (> 80% stenosis according to the Bluth criteria). Interestingly, 6 months earlier RICA PSV/EDV were 1.9/0.9 m/s. Figure 2A and B show CTA images of RICA. Despite the asymptomatic status, the multidisciplinary team members decided to qualify the patient for carotid artery angioplasty due to severe disease progression revealed in DUS. Coronarography revealed no coronary artery disease. Angiography confirmed significant RICA stenosis caused by FMD (Figure 2C). With distal neuroprotection (FilterWire EZ, Boston Scientific, Natick, MA, USA), angioplasty with a 4.0 × 20 mm balloon was performed (Figure 2D). The immediate result was optimal, and no stent implantation was required (Figure 2E). The periprocedural and postprocedural period was uneventful. For the next 36 months of follow-up the patient has remained neurologically asymptomatic with a preserved RICA angioplasty effect and stable LICA image in DUS.

Bottom Line: If the result of balloon angioplasty was not satisfactory (> 30% residual stenosis, dissection), stent placement was scheduled.The FMD group was younger (47.9 ±7.5 years vs. 67.2 ±8.9 years, p = 0.0001), with higher prevalence of women (71.4% vs. 32.7%, p = 0.0422), a higher rate of dissected lesions (57.1% vs. 4.6%, p = 0.0002) and less severe stenosis (73.4% vs. 83.9%, p = 0.0070) as compared to the non-FMD group.Fibromuscular dysplasia is rare among patients referred for CAS.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

ABSTRACT

Introduction: Fibromuscular dysplasia (FMD) is an infrequent non-inflamatory disease of unknown etiology that affects mainly medium-size arteries. The prevalence of FMD among patients scheduled for endovascular treatment of carotid artery stenosis is unknown.

Aim: To evaluate the prevalence and treatment options of carotid FMD in patients scheduled for carotid artery stenting (CAS).

Material and methods: Between Jan 2001 and Dec 2013, 2012 CAS procedures were performed in 1809 patients (66.1% men; age 65.3 ±8.4 years, 49.2% symptomatic). In case of FMD suspicion in Doppler-duplex ultrasound (DUS), computed tomography angiography was performed for aortic arch and extracranial and intracranial artery imaging. For invasive treatment of FMD carotid stenosis, balloon angioplasty was considered first. If the result of balloon angioplasty was not satisfactory (> 30% residual stenosis, dissection), stent placement was scheduled. All patients underwent follow-up DUS and neurological examination 3, 6 and 12 months after angioplasty, then annually.

Results: There were 7 (0.4%) (4 symptomatic) cases of FMD. The FMD group was younger (47.9 ±7.5 years vs. 67.2 ±8.9 years, p = 0.0001), with higher prevalence of women (71.4% vs. 32.7%, p = 0.0422), a higher rate of dissected lesions (57.1% vs. 4.6%, p = 0.0002) and less severe stenosis (73.4% vs. 83.9%, p = 0.0070) as compared to the non-FMD group. In the non-FMD group the prevalence of coronary artery disease was higher (65.1% vs. 14.3% in FMD group, p = 0.009). All FMD patients underwent successful carotid artery angioplasty with the use of neuroprotection devices. In 4 cases angioplasty was supported by stent implantation.

Conclusions: Fibromuscular dysplasia is rare among patients referred for CAS. In case of significant FMD carotid stenosis, it may be treated with balloon angioplasty (stent supported if necessary) with optimal immediate and long-term results.

No MeSH data available.


Related in: MedlinePlus