Abstract
To date, few study has defined the exact role or utility of intravascular ultrasound (IVUS) in the diagnosis and treatment of renal artery fibromuscular dysplasia (FMD). We investigated whether using an IVUS would provide additional insights in the hypertensive patients with focal renal artery FMD. A prospective, observational study, including all patients with focal renal artery FMD admitted to the Ruijin hospital during 6 consecutive years (2015–2021). Based on IVUS imaging, focal FMD patients were classified as two subtypes: intima-media thickening (IMT) and negative remodeling (NR) of the whole vessel. A total of 36 consecutive patients (24 ± 7, 13–39 years) with focal renal artery FMD were enrolled. Angiographic unifocal type was present in 22 (61.1%) patients and tubular type was present in 14 (38.9%) patients. Among 22 patients with unifocal, IVUS showed that 18 (81.8%) had IMT and 4 (18.2%) had NR. 14 patients with tubular, IVUS showed 3 (21.4%) had IMT and 11 (78.6%) had NR. No difference in age of onset, gender, BMI, initial BP levels were found between IMT and NR subtypes. However, hypertension cure rates of short-term (48 h after angioplasty) (76.2% vs. 26.7%, p = 0.004) and long-term (1–6years) (90.5% vs. 20.0%, p < 0.001) were higher in patients with IMT than in those with NR subtype. In present study, we described a new classification of focal renal artery FMD into IMT or NR subtype based on IVUS. Renal FMD Patients with IMT subtype were more likely to achieve cure of hypertension.
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References
Persu A, Giavarini A, Touze E, Januszewicz A, Sapoval M, Azizi M, et al. European consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2014;32:1367–78.
Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, et al. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation. 2014;129:1048–78.
Slovut DP, Olin JW. Fibromuscular dysplasia. N Engl J Med. 2004;350:1862–71.
Harrison EG Jr., McCormack LJ. Pathologic classification of renal arterial disease in renovascular hypertension. Mayo Clin Proc. 1971;46:161–7.
Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M, et al. First international consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2019;37:229–52.
Savard S, Steichen O, Azarine A, Azizi M, Jeunemaitre X, Plouin PF. Association between 2 angiographic subtypes of renal artery fibromuscular dysplasia and clinical characteristics. Circulation. 2012;126:3062–9.
Pappaccogli M, Di Monaco S, Warchol-Celinska E, Lorthioir A, Amar L, Aparicio LS, et al. The European/International Fibromuscular Dysplasia Registry and Initiative (FEIRI)-clinical phenotypes and their predictors based on a cohort of 1000 patients. Cardiovasc Res. 2021;117:950–9.
McCormack LJ, Poutasse EF, Meaney TF, Noto TJ Jr., Dustan HP. A pathologic-arteriographic correlation of renal arterial disease. Am Heart J. 1966;72:188–98.
Nissen SE, Yock P. Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation. 2001;103:604–16.
Gowda MS, Loeb AL, Crouse LJ, Kramer PH. Complementary roles of color-flow duplex imaging and intravascular ultrasound in the diagnosis of renal artery fibromuscular dysplasia: should renal arteriography serve as the “gold standard”? J Am Coll Cardiol. 2003;41:1305–11.
Prasad A, Zafar N, Mahmud E. Assessment of renal artery fibromuscular dysplasia: angiography, intravascular ultrasound (with virtual histology), and pressure wire measurements. Catheter Cardiovasc Inter. 2009;74:260–4.
McLaughlin DP, Kelly RV, Santa-Cruz RA, Stouffer GA. Images in cardiovascular medicine. Renal fibromuscular dysplasia. Circulation. 2005;112:e278–279.
Hoshino Y, Nakamura T, Nakano A, Isobe Z, Suguta M, Tomita T, et al. Successful treatment of renovascular hypertension due to fibromuscular dysplasia by intravascular ultrasound-guided atherectomy. Nephron. 2002;91:521–5.
Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72:e53–e90.
Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:1555–70.
Mintz GS, Painter JA, Pichard AD, Kent KM, Satler LF, Popma JJ, et al. Atherosclerosis in angiographically “normal” coronary artery reference segments: an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol. 1995;25:1479–85.
van Twist DJL, de Leeuw PW, Spiering W, Rossi GP, Dominiczak AF, Jennings GLR, et al. Unifocal and Multifocal Fibromuscular Dysplasia. Hypertension. 2019;73:7–12.
van Twist DJL, de Heer PWM, Houben A, de Haan MW, de Leeuw PW, Kroon AA. Differences in renal hemodynamics and renin secretion between patients with unifocal and multifocal fibromuscular dysplasia. J Hypertens. 2018;36:1729–35.
Plouin PF, Baguet JP, Thony F, Ormezzano O, Azarine A, Silhol F, et al. High Prevalence of Multiple Arterial Bed Lesions in Patients With Fibromuscular Dysplasia: The ARCADIA Registry (Assessment of Renal and Cervical Artery Dysplasia). Hypertension. 2017;70:652–8.
Louis R, Levy-Erez D, Cahill AM, Meyers KE. Imaging studies in pediatric fibromuscular dysplasia (FMD): a single-center experience. Pediatr Nephrol. 2018;33:1593–9.
Green R, Gu X, Kline-Rogers E, Froehlich J, Mace P, Gray B, et al. Differences between the pediatric and adult presentation of fibromuscular dysplasia: results from the US Registry. Pediatr Nephrol. 2016;31:641–50.
Olin JW. Is fibromuscular dysplasia a single disease? Circulation. 2012;126:2925–7.
Kincaid OW, Davis GD, Hallermann FJ, Hunt JC. Fibromuscular dysplasia of the renal arteries. Arteriographic features, classification, and observations on natural history of the disease. Am J Roentgenol Radium Ther Nucl Med. 1968;104:271–82.
Yang YK, Zhang Y, Meng X, Yang KQ, Jiang XJ, Wu HY, et al. Clinical characteristics and treatment of renal artery fibromuscular dysplasia with percutaneous transluminal angioplasty: a long-term follow-up study. Clin Res Cardiol. 2016;105:930–7.
Mishima E, Umezawa S, Suzuki T, Fujimura M, Abe M, Hashimoto J, et al. Low frequency of cervicocranial artery involvement in Japanese with renal artery fibromuscular dysplasia compared with that of Caucasians. Clin Exp Nephrol. 2018;22:1294–19.
Funding
This study was supported by National Natural Science Foundation of China [81800339, 81900440, 81901496]; Natural Science Foundation of Shanghai Science and Technology Committee [18ZR1431800, 21ZR1454100]; Fund of Shanghai Municipal Commission of Health and Family Planning [201940413, 20194Y0171, 20204Y0007].
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Kang, Y., Wu, Q., Xu, J. et al. Intravascular ultrasound provides additional insights in the hypertensive patients with focal renal artery fibromuscular dysplasia. Hypertens Res 46, 1407–1416 (2023). https://doi.org/10.1038/s41440-023-01216-y
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DOI: https://doi.org/10.1038/s41440-023-01216-y
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