The Experts below are selected from a list of 1890 Experts worldwide ranked by ideXlab platform
Jacqueline Saw - One of the best experts on this subject based on the ideXlab platform.
-
case reports of coronary Fibromuscular Dysplasia and spontaneous coronary artery dissections
Catheterization and Cardiovascular Interventions, 2019Co-Authors: Carolyn Lee, Andrew Starovoytov, Jacqueline SawAbstract:Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome especially in women. The most common underlying predisposing cause of SCAD is Fibromuscular Dysplasia (FMD), a non-inflammatory arteriopathy that results in weakening of the affected arteries, and can cause dissection or aneurysm. Coronary FMD (CFMD) was described as rare, and was shown to cause SCAD in histopathological case reports. Unfortunately, CFMD is challenging to diagnose on coronary angiography, as the findings can be similar to other causes of coronary artery disease. Therefore, we illustrate two case examples of CFMD on coronary angiography, and highlight findings on optical coherence tomography to aid diagnosis.
-
histopathology of coronary Fibromuscular Dysplasia causing spontaneous coronary artery dissection
Jacc-cardiovascular Interventions, 2018Co-Authors: Nathaniel Moulson, James K Kelly, Bilal M Iqbal, Jacqueline SawAbstract:Fibromuscular Dysplasia (FMD) is strongly associated with spontaneous coronary artery dissection (SCAD), with concomitant occurrence in 60% to 70% [(1)][1]. However, histopathological evidence of coronary FMD causing SCAD is rare [(2,3)][2]. We report a 57-year-old woman who presented with an
-
angiographic and intracoronary manifestations of coronary Fibromuscular Dysplasia
Circulation, 2016Co-Authors: Jacqueline Saw, Heather L Gornik, Hiram G Bezerra, Lindsay S Machan, G John B ManciniAbstract:Background—We previously described a strong association between Fibromuscular Dysplasia (FMD) and spontaneous coronary artery dissection. Angiographic manifestations of coronary FMD aside from dissection were considered rare. However, we observed several coronary FMD angiographic abnormalities with corresponding optical coherence tomography abnormalities. Methods and Results—Baseline demographics and imaging of patients with suspected coronary FMD at Vancouver General Hospital were reviewed. Presence of multifocal (string-of-beads) extracoronary FMD was confirmed by 2 specialists. In these patients, coronary angiographic findings (excluding dissected segments) were reviewed and classified by 2 experienced angiographers for irregular stenosis, that is, stenosis with irregular borders in a focal or diffuse pattern with/without systolic accentuation; smooth stenosis, diffuse or focal; segmental dilatation/ectasia; and tortuosity. Optical coherence tomography was performed in a subset of patients. Of 32 patie...
-
spontaneous coronary artery dissection associated with β hcg injections and Fibromuscular Dysplasia
Canadian Journal of Cardiology, 2014Co-Authors: Mathieu Lempereur, Jasmine Grewal, Jacqueline SawAbstract:Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome predominantly affecting younger women. SCAD is often associated with predisposing arterial abnormalities and precipitating emotional, physical, and hormonal stressors. We previously showed that Fibromuscular Dysplasia is strongly associated with SCAD and may be a causative factor. Hormonal changes related to pregnancy and sex hormones have also been shown to be an important cause of SCAD. We describe the first case report, to our knowledge, of SCAD associated with β-human growth hormone injections in a patient with concomitant FMD.
-
spontaneous coronary artery dissection in patients with Fibromuscular Dysplasia a case series
Circulation-cardiovascular Interventions, 2012Co-Authors: Jacqueline Saw, Rohan Poulter, Anthony Fung, David Wood, Jaap Hamburger, Christopher E BullerAbstract:Young women with acute coronary syndrome (ACS) frequently have nonatherosclerotic coronary artery disease (NACAD) and may be misdiagnosed. Coronary Fibromuscular Dysplasia (CFMD) commonly is overlooked, as the angiographic appearance is often subtle. Our group previously described CFMD as a diffuse obliterative disease starting abruptly at the mid-distal vessel, involving long segments.1 Spontaneous coronary dissection (SCAD) is another common form of NACAD and may be superimposed on CFMD, causing ACS. We report the first case series of SCAD and concomitant Fibromuscular Dysplasia (FMD). ### Case 1 (Figure 1) Figure 1. Case 1. A Coronary angiogram of the right coronary artery (RCA) showing diffuse stenosis from the mid-segment to the posterior descending artery. B Optical coherence tomography (OCT) image of the normal proximal RCA (* corresponding to A ). C OCT image showing intramural hematoma in the distal RCA (+ corresponding to A ). D Carotid angiogram showing shelf-like Fibromuscular Dysplasia (FMD) lesion at the ostium of the left internal carotid artery (*), followed by mild irregularities in the proximal left carotid artery. E Iliac angiogram showing diffuse mild FMD in the left external iliac artery (*). A 35-year-old African female with no cardiovascular (CV) risk factors presented on April 18, 2011 with persistent chest pain for 2 days while doing aerobic exercises. ECG showed T-inversion anteriorly and inferiorly, and troponin I (Tn-I) peaked at 4.2μmol/L. Coronary angiogram showed diffuse severe stenosis from mid-right coronary artery (RCA) to the distal posterior descending artery with TIMI3 flow. A subsequent optical coherence tomography (OCT) showed coronary dissection with extensive intramural hematoma, and she was treated with stents. She had incidental bilateral external iliac artery FMD, and her carotid computer tomography angiography (CTA) showed a flap at the origin of the left carotid artery, prompting catheterization that confirmed FMD of both carotid …
Pierre Francois Plouin - One of the best experts on this subject based on the ideXlab platform.
-
high prevalence of multiple arterial bed lesions in patients with Fibromuscular Dysplasia the arcadia registry assessment of renal and cervical artery Dysplasia
Hypertension, 2017Co-Authors: Pierre Francois Plouin, C Oppenheim, Jeanphilippe Baguet, Frederic Thony, Olivier Ormezzano, Arshid Azarine, Francois Silhol, Beatrice Bouhanick, Louis Boyer, Alexandre PersuAbstract:Fibromuscular Dysplasia (FMD) commonly affects the renal and cervical arteries but has been described to affect other vascular beds as well. The prevalence of and clinical characteristics associate...
-
european consensus on the diagnosis and management of Fibromuscular Dysplasia
Journal of Hypertension, 2014Co-Authors: Alexandre Persu, M Sapoval, Xavier Jeunemaitre, Emmanuel Touze, Alessandra Giavarini, Andrzej Januszewicz, Michel Azizi, Xavier Barral, Alberto Morganti, Pierre Francois PlouinAbstract:The main objectives of this expert consensus are to raise awareness about Fibromuscular Dysplasia, which is more frequent and more often systemic than previously thought and can sometimes have devastating consequences; to provide up-to-date recommendations for the diagnosis, evaluation, and management of the disease; and to identify research priorities. The emphasis has been put on recommendations for daily practice. The main topics covered include definition, classification, diagnosis, and management of Fibromuscular Dysplasia in adult patients with symptomatic involvement of the renal arteries, supra-aortic trunks, and digestive and peripheral arteries.
-
efficacy of revascularization for renal artery stenosis caused by Fibromuscular Dysplasia a systematic review and meta analysis
Hypertension, 2010Co-Authors: Ludovic Trinquart, Claire Mouniervehier, M Sapoval, Nathalie Gagnon, Pierre Francois PlouinAbstract:In patients with Fibromuscular Dysplasia and renal artery stenosis, renal artery revascularization has been used to cure hypertension or to improve blood pressure control. To provide an up-to-date assessment of the benefits and risks associated with revascularization in this condition, we performed a systematic review of studies in which hypertensive patients with Fibromuscular Dysplasia renal artery stenosis underwent percutaneous transluminal renal angioplasty or surgical reconstruction. We assessed how often periprocedural complications and hypertension cure and improvement occurred. We selected 47 angioplasty studies (1616 patients) and 23 surgery studies (1014 patients). Combined rates of hypertension cure, defined according to the criteria in each study, after angioplasty or surgery were estimated to be 46% (95% CI: 40% to 52%) and 58% (95% CI: 53% to 62%), respectively, with substantial variations across studies. The probability of being cured was negatively associated with patient age and time of publication. Cure rates using current definitions of hypertension cure (blood pressure <140/90 mm Hg without treatment) were only 36% and 54% after angioplasty and surgery, respectively. The combined risks of periprocedural complications were 12% and 17% after angioplasty and surgery, respectively, with less major complications after angioplasty than surgery (6% versus 15%). In conclusion, angioplasty or surgical revascularization yielded moderate benefits in patients with Fibromuscular Dysplasia renal artery stenosis, with substantial variation across studies. The blood pressure outcome was strongly influenced by patient age.
-
possible familial origin of multifocal renal artery Fibromuscular Dysplasia
Journal of Hypertension, 1997Co-Authors: Isabelle Panniermoreau, Philippe Grimbert, Beatrice Fiquetkempf, Albert Vuagnat, Xavier Jeunemaitre, Pierre Corvol, Pierre Francois PlouinAbstract:Objective To describe phenotypes and estimate the prevalence of familial cases of renal artery Fibromuscular Dysplasia (FMD). Patients and setting One hundred and four unrelated hypertensive patients (94 women) with renal artery Fibromuscular Dysplasia documented on angiography and classified as having multifocal or unifocal lesions. Familial cases were defined as those with angiographic evidence of renal artery FMD in at least one sibling. Results Eighty-one patients had multifocal and 16 had unifocal FMD. Both types of stenosis were present in seven patients. Fifty-four patients had bilateral FMD, including the seven patients with both unifocal and multifocal lesions. The 16 patients with unifocal FMD were younger, more likely to be men, and more commonly had unilateral stenoses, stenoses exceeding 75% and a small ischemic kidney than the 81 patients with multifocal lesions. Eleven cases were identified as familial on the basis of FMD having been documented in at least one sibling (eight sibling pairs and three trios). All probands were women and exhibited multifocal lesions. FMD was more often bilateral in familial than it was in apparently sporadic cases. Conclusions Multifocal FMD was mostly found in women and unifocal FMD in young men with more severe stenosis and kidney ischemia. The documented prevalence of familial cases was 11% in this series, the true prevalence being probably higher because only a few siblings were examined by angiography. Familial cases all exhibited the multifocal type and were more commonly bilateral than were sporadic cases.
Jeffrey W Olin - One of the best experts on this subject based on the ideXlab platform.
-
prevalence of intracranial aneurysm in women with Fibromuscular Dysplasia a report from the us registry for Fibromuscular Dysplasia
JAMA Neurology, 2017Co-Authors: Henry D Lather, Heather L Gornik, Jeffrey W Olin, Steven T Heidt, Esther S H Kim, Daniella Kadiandodov, Aditya Sharma, Bruce H Gray, Michael R Jaff, Yungwei ChiAbstract:Importance The prevalence of intracranial aneurysm in patients with Fibromuscular Dysplasia (FMD) is uncertain. Objective To examine the prevalence of intracranial aneurysm in women diagnosed with FMD. Design, Setting, and Participants This cross-sectional study included 669 women with intracranial imaging registered in the US Registry for Fibromuscular Dysplasia, an observational disease-based registry of patients with FMD confirmed by vascular imaging and currently enrolling at 14 participating US academic centers. Registry enrollment began in 2008, and data were abstracted in September 2015. Patients younger than 18 years at the time of FMD diagnosis were excluded. Imaging reports of all patients with reported internal carotid, vertebral, or suspected intracranial artery aneurysms were reviewed. Only saccular or broad-based aneurysms 2 mm or larger in greatest dimension were included. Extradural aneurysms in the internal carotid artery were included; fusiform aneurysms, infundibulae, and vascular segments with uncertainty were excluded. Main Outcomes and Measures Percentage of women with FMD with intracranial imaging who had an intracranial aneurysm. Results Of 1112 female patients in the registry, 669 (60.2%) had undergone intracranial imaging at the time of enrollment (mean [SD] age at enrollment, 55.6 [10.9] years). Of the 669 patients included in the analysis, 86 (12.9%; 95% CI, 10.3%-15.9%) had at least 1 intracranial aneurysm. Of these 86 patients, 25 (53.8%) had more than 1 intracranial aneurysm. Intracranial aneurysms 5 mm or larger occurred in 32 of 74 patients (43.2%), and 24 of 128 intracranial aneurysms (18.8%) were in the posterior communicating or posterior arteries. The presence of intracranial aneurysm did not vary with location of extracranial FMD involvement. A history of smoking was significantly associated with intracranial aneurysm: 42 of 78 patients with intracranial aneurysm (53.8%) had a smoking history vs 163 of 564 patients without intracranial aneurysm (28.9%; P Conclusions and Relevance The prevalence of intracranial aneurysm in women diagnosed with FMD is significantly higher than reported in the general population. Although the clinical benefit of screening for intracranial aneurysm in patients with FMD has yet to be proven, these data lend support to the recommendation that all patients with FMD undergo intracranial imaging if not already performed.
-
natural history of cervical artery Fibromuscular Dysplasia and associated neurovascular events
Journal of the American College of Cardiology, 2016Co-Authors: Daniella Kadiandodov, Judith Z Goldfinger, Jacqueline Hairston, Jeffrey W OlinAbstract:Fibromuscular Dysplasia (FMD) is a non-atherosclerotic, non-inflammatory arteriopathy that most often affects the carotid and renal arteries. In the US Registry for FMD an aneurysm was identified in 21.7% and dissection in 25.7% of patients before or at FMD diagnosis. Occurrence of vascular events
-
coronary artery manifestations of Fibromuscular Dysplasia
Journal of the American College of Cardiology, 2014Co-Authors: Katherine C Michelis, Jeffrey W Olin, Daniella Kadiandodov, Valentina Descamard, Jason C KovacicAbstract:Fibromuscular Dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic “string of beads” that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies.
-
clinical manifestations of Fibromuscular Dysplasia vary by patient sex a report of the united states registry for Fibromuscular Dysplasia
Journal of the American College of Cardiology, 2013Co-Authors: Jeffrey W Olin, Bruce H Gray, Michael R Jaff, Michael J Bacharach, James B Froehlich, Xiaokui Gu, Barry T Katzen, Eva Klinerogers, Pamela Mace, Alan H MatsumotoAbstract:To the Editor: Fibromuscular Dysplasia (FMD) is an uncommon arteriopathy which can result in stenosis, aneurysm, dissection, and/or occlusion of arteries. It most commonly affects the renal, extracranial carotid, and vertebral arteries but can affect any artery. Although FMD occurs primarily in
-
diagnosis management and future developments of Fibromuscular Dysplasia
Journal of Vascular Surgery, 2011Co-Authors: Jeffrey W Olin, Brett A SealoveAbstract:Fibromuscular Dysplasia (FMD) is a nonatherosclerotic noninflammatory vascular disease that primarily affects women from age 20 to 60, but may also occur in infants and children, men, and the elderly. It most commonly affects the renal and carotid arteries but has been observed in almost every artery in the body. FMD has been considered rare and thus is often underdiagnosed and poorly understood by many health care providers. There are, however, data to suggest that FMD is much more common than previously thought, perhaps affecting as many as 4% of adult women. When it affects the renal arteries, the most common presentation is hypertension. When it affects the carotid or vertebral arteries, the patient may present with transient ischemic attack or stroke, or dissection. An increasing number of patients are asymptomatic and are only discovered incidentally when imaging is performed for some other reason or by the detection of an asymptomatic bruit. FMD should be considered in the differential diagnosis of a young person with a cervical bruit; a "swishing" sound in the ear(s); transient ischemic attack, stroke, or dissection of an artery; or in individuals aged ≤35 years with onset hypertension. Treatment consists of antiplatelet therapy for asymptomatic individuals and percutaneous balloon angioplasty for patients with indications for intervention. Patients with aneurysms should be treated with a covered stent or open surgical repair. Little new information has been published about FMD in the last 40 years. The recently instituted International Registry for Fibromuscular Dysplasia will remedy that situation and provide observational data on a large numbers of patients with FMD.
Christine Manti - One of the best experts on this subject based on the ideXlab platform.
-
coexistence of hypertrophic cardiomyopathy and Fibromuscular Dysplasia of the superior mesenteric artery
The New England Journal of Medicine, 2001Co-Authors: Michael Safioleas, John D Kakisis, Christine MantiAbstract:To the Editor: Hypertrophic cardiomyopathy and Fibromuscular Dysplasia of the superior mesenteric artery that causes ischemic colitis are rare clinical entities. Their coexistence would probably be...
Jordan R Stern - One of the best experts on this subject based on the ideXlab platform.
-
endovascular repair of ruptured hepatic artery pseudoaneurysm secondary to Fibromuscular Dysplasia
Vascular and Endovascular Surgery, 2019Co-Authors: Kara A Rothenberg, Graeme E Mcfarland, Jordan R SternAbstract:We describe successful endovascular treatment of a patient with Fibromuscular Dysplasia of the celiac axis leading to development of a common hepatic artery pseudoaneurysm with contained rupture. An 81-year-old woman was transferred to our quaternary care center with concern for a hepatic artery rupture. Further imaging demonstrated a common hepatic artery pseudoaneurysm with surrounding hematoma as well as multifocal areas of narrowing and dilatation in the celiac trunk consistent with Fibromuscular Dysplasia. A similar pattern was subsequently identified in the bilateral renal and carotid arteries. The patient underwent successful endovascular exclusion of the pseudoaneurysm with a balloon-expandable covered stent and was discharged home without incident. Fibromuscular Dysplasia is a nonatherosclerotic arteriopathy that can lead to stenosis, occlusion, dissection, and aneurysm formation. While it primarily affects the carotid and renal arteries, there are rare case reports involving the mesenteric vascu...
-
endovascular repair of ruptured hepatic artery pseudoaneurysm secondary to Fibromuscular Dysplasia
Vascular and Endovascular Surgery, 2019Co-Authors: Kara A Rothenberg, Graeme E Mcfarland, Jordan R SternAbstract:We describe successful endovascular treatment of a patient with Fibromuscular Dysplasia of the celiac axis leading to development of a common hepatic artery pseudoaneurysm with contained rupture. An 81-year-old woman was transferred to our quaternary care center with concern for a hepatic artery rupture. Further imaging demonstrated a common hepatic artery pseudoaneurysm with surrounding hematoma as well as multifocal areas of narrowing and dilatation in the celiac trunk consistent with Fibromuscular Dysplasia. A similar pattern was subsequently identified in the bilateral renal and carotid arteries. The patient underwent successful endovascular exclusion of the pseudoaneurysm with a balloon-expandable covered stent and was discharged home without incident. Fibromuscular Dysplasia is a nonatherosclerotic arteriopathy that can lead to stenosis, occlusion, dissection, and aneurysm formation. While it primarily affects the carotid and renal arteries, there are rare case reports involving the mesenteric vasculature. Endovascular therapy appears to be a feasible treatment option for the complicated sequelae of this condition in the rare case of mesenteric arterial involvement.