Fibromuscular dysplasia of the internal carotid artery. Personal experience with 13 cases and literature review

From January 1990 to December 1997, the authors observed 13 cases of fibrom uscular dysplasia of the internal carotid artery. Four patients presented t ransient ischemic attacks, one amaurosis fugax, two suffered from a minor s troke, four had non-focalized ischemic cerebral symptoms and two were asymp tomatic. At angiography, all patients showed a typical image of "string of beads". Seven patients were operated on. Six had endoluminal graduated dilatation, with rigid dilators up to 4.5 mm, associated with thrombendarterectomy of t he bifurcation in three and to correction of a kink in one case. In one cas e a venous interposition graft was done to exclude a saccular microaneurysm of the dysplasic internal carotid artery. In another case, backflow was in sufficient after endoluminal dilatation, and a long venous patch allowed to restitute a normal vascular lumen. There was neither postoperative mortali ty nor stroke. Six patients, asymptomatic or with non focalized symptoms, w ere treated medically. During a mean follow-up of 47 months, only one of the 13 patients developed a transient ischemic attack; the patient had not been operated on and rece ived only medical treatment. Prevalence, etiopathology, diagnosis and management of fibromuscular dyspla sia of the internal carotid artery are discussed. Fibromuscular dysplasia i s a rare cause of cerebral ischemia. For asymptomatic lesions, a conservati ve approach seems appropriate. Surgery is only to be considered for symptom atic lesions. Surgical graduated endoluminal dilatation, where necessary co mbined with standard endarterectomy of the carotid bifurcation, is a safe, efficient and durable operation. Some complex cases of fibromuscular dyspla sia may necessitate patch insertion or excision and graft interposition.