A 57-year-old woman presented to the emergency department (ED) with left arm and leg weakness that resolved after 2 hours. She had a similar episode 1 week previously. She was otherwise healthy and active, although her blood pressure was 160/94 mm Hg, without a previous history of hypertension. She underwent a computed tomogram (CT) of the head that was negative for bleeding or stroke. She then had a carotid duplex ultrasound examination, which showed a focal area of increased velocity in the distal internal carotid artery (ICA) distally without any significant plaque formation at the bifurcation or the proximal ICA. It was felt that she needed a carotid angiogram to better delineate the disease process.
The contrast angiogram revealed fibromuscular dysplasia (FMD) in the mid and distal cervical ICA (Figure 25-1). Further investigation also showed FMD in both common iliac arteries (Figure 25-2) and both renal arteries (Figures 25-3 and 25-4). She denied any claudication symptoms. Renal artery intervention was discussed for her hypertension.
She agreed and a balloon angioplasty of the right renal artery was successfully carried out. Her carotid disease was managed with antiplatelet therapy and she has had no recurrence of her symptoms.