From the Guidelines
Fibromuscular dysplasia (FMD) is typically treated with a combination of medications and lifestyle modifications, with interventional procedures reserved for severe cases, as recommended by the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline 1. Treatment primarily focuses on managing blood pressure and preventing complications.
- Antiplatelet medications like aspirin (81-325 mg daily) are commonly prescribed to reduce the risk of blood clots, as suggested by the guideline 1.
- Blood pressure control is essential, often using ACE inhibitors or angiotensin receptor blockers.
- For patients with severe narrowing of arteries, procedures such as angioplasty may be necessary to widen affected vessels, as stated in the guideline 1. FMD can affect vision when it involves the carotid or ophthalmic arteries, potentially causing temporary vision loss, blurry vision, or visual field defects due to reduced blood flow to the eye.
- In rare cases, it may lead to retinal artery occlusion or stroke affecting the visual cortex, resulting in permanent vision loss, as mentioned in the guideline 1. Regular eye examinations are important for FMD patients, especially those with carotid involvement.
- Patients should immediately report any sudden vision changes, as these could indicate a medical emergency requiring prompt intervention to preserve vision, as emphasized by the guideline 1. The 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease also recommends annual noninvasive imaging of the carotid arteries to detect changes in the extent or severity of disease 1. However, the effect on outcomes is unclear, and studies may be repeated less frequently once stability has been confirmed, as stated in the guideline 1. Additionally, carotid angioplasty with or without stenting is reasonable for patients with retinal or hemispheric cerebral ischemic symptoms related to FMD of the ipsilateral carotid artery, but comparative data addressing these methods of revascularization are not available, as mentioned in the guideline 1. It is essential to note that revascularization is not recommended for patients with asymptomatic FMD of a carotid artery, regardless of the severity of stenosis, as stated in the guideline 1. Overall, the treatment of FMD should be individualized and based on the severity of symptoms and the extent of disease, as recommended by the guideline 1.
From the Research
Treatment of Fibromuscular Dysplasia
- The treatment of fibromuscular dysplasia (FMD) depends on the location and severity of the disease, as well as the presence of symptoms 2.
- For patients with renal artery FMD and hypertension, primary angioplasty is recommended with the goal of curing the hypertension 2.
- If blood pressure fails to normalize after angioplasty, antihypertensive medications should be instituted according to the recommendations of the Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure VII 2.
- In patients with cerebrovascular FMD, antiplatelet agents are the cornerstone of therapy, and percutaneous angioplasty has emerged as the preferred treatment for symptomatic cerebrovascular FMD 2.
Effect of Fibromuscular Dysplasia on Vision
- There is no direct evidence in the provided studies on how fibromuscular dysplasia affects vision.
- However, it is known that FMD can lead to cerebrovascular accidents, which may potentially affect vision 3.
- Further research is needed to fully understand the impact of FMD on vision.
Additional Considerations
- Renal stenting in FMD may carry a high risk of late complications, including stent occlusion 4.
- Percutaneous transluminal angioplasty (PTA) with selective stenting has been shown to be safe and effective in treating renal artery stenosis caused by FMD 5.
- A comprehensive multidisciplinary care model and patient input are important for managing FMD, given its complexity and systemic presence 3.