2023 Volume 87 Issue 8 Pages 1145-
Fibromuscular dysplasia (FMD) is a major cause of renal artery stenosis in young people and accounts for approximately 10% of renovascular hypertension cases.1 A 17-year-old girl (body mass index: 17.9) visited hospital with the chief complaint of dyspnea at rest that had persisted for 1 month. On examination, her blood pressure was remarkably high (178/131 mmHg) and secondary hypertension was strongly suspected because right renal artery stenosis and post-stenotic dilation with right renal atrophy were observed on contrast-enhanced computed tomography scanning (Figure A,B). Renography revealed decreased accumulation of radioisotopes in the right kidney and further intervention by pressure wire examination revealed stenosis (Figure C). Optical coherence tomography (OCT) showed that the stenosis was not accompanied by plaque rupture, revealing fibroproliferation of the intima and hyperplasia of the tunica media (Figure D, Supplementary Movie 1). We finally diagnosed FMD and performed percutaneous transluminal renal angioplasty (PTRA: 4.0×20 mm), which improved the pressure gradient (Figure E,F). Postoperative angioscopy revealed a wavy and elastic-like appearance of the intima in the renal artery after PTRA, without atherosclerotic findings or intimal injury (Figure G, Supplementary Movie 2). The patient was discharged after her blood pressure and renogram normalized (Figure H,I). Observation using angioscopy and OCT may be useful for determining treatment strategies for FMD such as antiplatelet therapy.
Fibromuscular dysplasia findings from multimodal imaging. (A,B) Right renal artery stenosis (black and white arrowheads, respectively) revealed by contrast-enhanced computed tomography. (C) Pressure study pre-PTRA. (D, Upper & Lower) Optical coherence tomography showing fibroproliferation of the intima and hyperplasia of the tunica media. (E) Pre-PTRA angiography (stenotic lesion shown by white arrowhead), (F) post-PTRA angiography. (G) Angioscopy showing wavy appearance of intima of the right renal artery. (H) Pressure study post-PTRA. (I) Renogram showing normalized renal flow post-PTRA. PTRA, percutaneous transluminal renal angioplasty.
A.H. is a member of Circulation Journal’s Editorial Team.
Supplementary Movie 1. OCT of the renal artery before PTRA.
Supplementary Movie 2. Angioscopy of the renal artery after PTRA.
Please find supplementary file(s);
https://doi.org/10.1253/circj.CJ-23-0347
