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(Circulation. 2008;117:2542-2543.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

"String of Beads" Appearance of Bilateral Brachial Artery in Fibromuscular Dysplasia

Tsuyoshi Yoshimuta, MD; Koichi Akutsu, MD; Toshiya Okajima, MD; Yuiichi Tamori, MD; Yoshinori Kubota, BS; Satoshi Takeshita, MD

From the Department of Medicine (Cardiology) (T.Y., K.A., T.O., Y.T., S.T.) and the Laboratory of Clinical Physiology (Y.K.), National Cardiovascular Center, Osaka, Japan.

Correspondence to Satoshi Takeshita, MD, FACC, Department of Medicine (Cardiology), National Cardiovascular Center, 5–7–1 Fujishiro-dai, Suita, Osaka 565–8565, Japan. E-mail stake@muse.ocn.ne.jp

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

A 56-year-old woman presented with chest discomfort and underwent coronary angiography via a transradial route. Left brachial artery stenosis was suspected because of difficulty in passing with a 0.035-inch guide wire. Upper-extremity angiography showed presence of multiple stenoses and aneurysmal dilatations in her brachial artery (Figure 1). Subsequent to catheterization, the patient received duplex scanning using Aplio SSA-700A (Toshiba, Tokyo, Japan) using the advanced dynamic flow mode. This mode is associated with high resolution, wide dynamic range, and high frame rates and is capable of producing a superior angiograph-like vascular image. Duplex scanning showed serial stenoses alternating with aneurysmal dilatations over a length of approximately 10 cm in her bilateral brachial arteries, which is a typical "string of beads" appearance of fibromuscular dysplasia (FMD)¹ (Figure 2).

View larger version (101K):   Figure 1. Upper-extremity angiogram showing multiple stenoses and aneurysmal dilatations in the brachial artery.

View larger version (25K):   Figure 2. B-mode (left) and advanced dynamic flow mode (right) images demonstrating segmental stenoses and dilatations of the brachial artery, which shows the typical "string of beads" appearance of fibromuscular dysplasia.

FMD usually affects the renal and carotid arteries, and brachial artery involvement is very rare. To our knowledge, there have been only 4 cases of FMD involving bilateral brachial arteries reported thus far in the literature.² Pathologically, 3 main types of FMD have been identified, which include intimal fibroplasia, medial FMD, and periarterial fibroplasia.³ Among these, medial FMD is the most common, accounting for 70% to 95% of all fibromuscular vascular lesions.¹ As shown in . . . [Full Text of this Article]