Fibromuscular dysplasia (FMD) is a relatively rare reason for secondary hypertension, predominantly in young women. Intravascular ultrasound (IVUS) plays a potentially important role for defining the precise type of FMD and to properly direct treatment – balloon PTA. This may lead to better results.Design and method:
This is a clinical case of 25 year old woman. She was with arterial hypertension for the last 3 years, maximal values 200/100 mmHg, and self – measured on a centrally acting medication 130/80 mmHg. Ambulatory blood pressure monitoring showed elevated day and night blood pressure values. There were no clinical signs for aortic coarctation. TSH in the reference range. Smoking anamnesis. Low-dose estrogen-progesteron anticonception therapy in the past. Renal arteries Dopler – Vc 300 cm/sec for the distal right renal artery, Vc for the aorta 65 cm/sec. Contrast CT of the renal arteries and low extremities – inconclusive.Results:
Renovasography was performed and renal fibromuscular dysplasia with intimal fibrosis was diagnosed. Right renal artery – critical 99% stenosis of the low renal artery branch; 80% of the upper renal artery branch, collateralized through the capsular artery. Intravascular ultrasound was conducted: intimal hyperplasia of middle and distal segment; the proximal segment with echonegative areas, characteristic of medial necrosis. MLP 1.9 m2. A successive PTA with rising diameter drug eluting balloons was performed on top of premedication with aspirin and clopidogrel. Post-procedure blood pressure 90/60 mmHg.Conclusions:
The patient was discharged on dual antiplatelet therapy. 6 months later the home measured blood pressure monitoring was in the reference range without antihypertensive treatment. The use of IVUS in the treatment of FMD with PTA may lead to better and more durable clinical results. Still larger groups of patients are needed to precise IVUS-based treatment.