OCCLUSIVE FIBROMUSCULAR DISEASE OF ARTERIES SUPPLYING THE BRAIN - RESULTS OF SURGICAL-TREATMENT

Occlusive fibromuscular disease (FMD) of arteries supplying the brain is a documented cause of neurologic complications. From September 1976 to December 1994, 70 patients underwent surgery for occlusive FMD inv olving arteries supplying the brain, isolated dysplastic aneurysms and ceilings or kinkings were not included in this series. Twenty-two pat ients had experienced previous nonlethal ischemic stroke, 25 patients had experienced transient ischemic attacks, and 32 patients had verteb robasilar insufficiency with or without associated carotid symptoms. L esions involved one (n = 36) or two (n = 29) internal carotid arteries , and one (n = 18) or two (n = 14) vertebral arteries. Twenty-seven pa tients had simultaneous involvement of both carotid and vertebral arte ries, Ten patients had FMD at another site, four had intracranial aneu rysm, and four had an aberrant right subclavian artery. Seventy-seven carotid procedures including ST graduated intraluminal dilatations wer e performed and 18 vertebral arteries were revascularized. One patient (1.4%) died postoperatively from hemorrhagic stroke and two patients (2.8%) presented nonlethal stroke, Sixty-two patients were followed po stoperatively from 2 to 184 months (mean 86.2 +/- 54.4). Actuarial sur vival rates at 5 and 10 years were 96.4 +/- 5.0% and 82.1 +/- 14.9%, r espectively. Actuarial primary patency rate at 5 and 10 years was 94.3 +/- 5.5%. Actuarial probability of stroke-free survival rates at 5 an d 10 years were 94.2 +/- 5.6% and 88.6% +/- 10.3%, respectively. We co nclude that improvement of symptoms, prevention of stroke, and stable long-term results justify surgical treatment in symptomatic patients w ith FMD of arteries supplying the brain.