Endovascular Treatment of Fibromuscular Dysplasia of the Carotid Artery

Treatment of carotid fibromuscular dysplasia (FMD) in the past has been open graduated rigid carotid dilatation for symptomatic stenoses or segmental resection with saphenous vein interposition for aneurysms. The results of contemporary open surgical reports have shown the risk of stroke to be 1.4% to 2.8% and that of transient ischemic attack (TIA) to be 1.4% to 7.7%. Because high surgical exposure up to the first and second cervical vertebrae may be needed to ensure that safe dilatation is carried out under direct vision, rates of cranial nerve injury are higher (5.1% up to 58%) than those reported for carotid endarterectomy.

Endovascular treatment of renal FMD with balloon angioplasty has gained widespread acceptance. It is safe, effective, and durable. The enthusiasm for using endovascular techniques to treat carotid FMD lesions has been fueled by the higher morbidity rates of open surgery in some reports and by recent improvements in endovascular carotid stent technology.