Summary of "Daniella Kadian-Dodov, MD | Fibromuscular Dysplasia: Looking Beyond the String-of-Beads"
Scientific Concepts and Discoveries Presented
- Fibromuscular Dysplasia (FMD)
- FMD is characterized by heterogeneous presentations affecting various arteries, primarily impacting women in their prime.
- The condition is often identified through angiographic classification, distinguishing between multifocal (string of beads) and focal (single area of stenosis) forms.
- Historical context: First identified in a young boy with hypertension, leading to further studies and classifications in the 1960s and 1970s.
- Pathophysiology
- FMD is a non-atherosclerotic, non-inflammatory disease typically affecting mid to distal arteries.
- The disease can lead to complications such as aneurysms and dissections, with a significant prevalence in renal and cervical arteries.
- Diagnosis and Classification
- Diagnosis often involves imaging techniques like catheter-based angiography and CTA.
- Important mimickers of FMD include vasospasm and dissection healing, which can present similarly on imaging.
- Epidemiology
- The prevalence of FMD may be underestimated, with studies indicating it could affect millions of women in the U.S.
- Recent findings suggest that FMD is not as rare as previously thought, with incidental findings in healthy kidney donors and patients undergoing imaging for unrelated reasons.
- Genetic and Environmental Factors
- Genetic predispositions and environmental triggers (e.g., mechanical stress, smoking) may contribute to the development of FMD.
- Familial cases and studies on identical twins indicate a potential genetic component, though the exact mechanisms remain unclear.
- Clinical Manifestations
- Symptoms vary based on the artery involved, with hypertension being a common presenting sign for renal artery FMD.
- A significant number of patients with FMD also have associated conditions such as spontaneous coronary artery dissection (SCAD) and aneurysms.
- Management and Follow-Up
- Management strategies include lifestyle modifications and careful monitoring, particularly for those with aneurysms or dissections.
- Recommendations against certain activities (e.g., intense isometric exercise, chiropractic neck manipulation) due to increased risk of dissection.
- Regular follow-up imaging is advised, particularly for patients with identified vascular anomalies.
Methodology and Key Points
- Diagnosis Approach
- Use of imaging (CTA preferred) for screening in patients with spontaneous dissections or aneurysms.
- Regular follow-up and monitoring of patients with FMD, especially those with multifocal or focal lesions.
- Management Recommendations
- Aspirin therapy (81 mg daily) for all patients with FMD.
- Avoidance of specific activities that may increase dissection risk.
- Genetic testing may be warranted in cases of multiple vascular findings.
Researchers and Sources Featured
- Daniella Kadian-Dodov, MD: Presenter and primary researcher discussing FMD.
- Dr. Olan: Senior partner and mentor to Dr. Kadian-Dodov, involved in FMD research.
- Dr. Kichic: Principal investigator for the Define FMD study.
- Annette King: Conducts biopsies for patient enrollment.
- Valentina: Laboratory technician managing patient samples.
- Dr. Olan's team: Various collaborators in the research efforts.
Category
Science and Nature
