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(Circulation. 2009;120:e157-e158.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Adventitial Fibromuscular Dysplasia of the Renal Artery

Management Challenges of Nonatherosclerotic Renal Artery Stenosis

Rory B. Weiner, MD; Thomas J. Kiernan, MD; Bryan P. Yan, MBBS; Kenneth Rosenfield, MD; Michael R. Jaff, DO

From the Division of Cardiology, Department of Medicine (R.B.W.) and Section of Vascular Medicine, Division of Cardiology, Department of Medicine (T.J.K., K.R., M.R.J.), Massachusetts General Hospital, Boston; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and the Chinese University of Hong Kong, Hong Kong (B.P.Y.); and Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (B.P.Y.).

Correspondence to Rory B. Weiner, MD, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5, 55 Fruit St, Boston, MA 02114. E-mail rweiner@partners.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 19-year-old healthy woman presented with new onset of severe migrainous headache. She did not take medications or use illicit drugs. There was no personal or family history of hypertension. Physical examination revealed a blood pressure of 220/130 mm Hg in both arms. There was no fourth heart sound. She had full and symmetric pulses in the upper and lower extremities with no radial/femoral delay. There were no carotid, subclavian, or abdominal bruits. Fundoscopic examination revealed normal retinal arteries without hypertensive retinopathy. Renal function and serum potassium were normal. Renal artery duplex ultrasonography revealed elevated peak systolic and end-diastolic velocities in the mid to distal portion of the right renal artery, consistent with severe right renal artery stenosis. The left renal artery was normal. The right kidney measured 8.8 cm with atrophy of the right cortical margin. The left kidney was 11.5 cm. There were normal renal resistive indexes bilaterally.

She had persistent headache, labile blood pressure, and intolerance to her oral antihypertensive medications and was referred for renal arteriography. Selective angiography demonstrated a severe stenosis in the mid right renal artery (Figure 1A). Intravascular ultrasound identified a normal distal right renal artery reference segment (Figure 2A). At the area of stenosis in the mid vessel, there was a marked decrease in the minimum luminal diameter (Figure 2B). The lesion was fibrocalcific and appeared to involve the adventitia. Percutaneous transluminal renal angioplasty with a 3.0x20-mm balloon (Quantum Maverick, Boston Scientific Corp, Natick, . . . [Full Text of this Article]