Occlusive Fibromuscular Disease of Arteries Supplying the Brain: Results of Surgical Treatment

Occlusive fibromuscular disease (FMD) of arteries supplying the brain is a documented cause of neurologic complications. From September 1976 to December 1994, 70 patients underwent surgery for occlusive FMD involving arteries supplying the brain. Isolated dysplastic aneurysms and coilings or kinkings were not included in this series. Twenty-two patients had experienced previous nonlethal ischemic stroke, 25 patients had experienced transient ischemic attacks, and 32 patients had vertebrobasilar insufficiency with or without associated carotid symptoms. Lesions involved one (n = 36) or two (n = 29) internal carotid arteries, and one (n = 18) or two (n = 14) vertebral arteries. Twenty-seven patients had simultaneous involvement of both carotid and vertebral arteries. Ten patients had FMD at another site, four had intracranial aneurysm, and four had an aberrant right subclavian artery. Seventy-seven carotid procedures including 67 graduated intraluminal dilatations were performed and 18 vertebral arterties were revascularized. One patient (1.4%) died postoperatively from hemorrhagic stroke and two patients (2.8%) presented nonlethal stroke. Sixty-two patients were followed postoperatively from 2 to 184 months (mean 86.2 ± 54.4). Actuarial survival rates at 5 and 10 years were 96.4 ± 5.0% and 82.1 ± 14.9%, respectively. Actuarial primary patency rate at 5 and 10 years was 94.3 ± 5.5%. Actuarial probability of stroke-free survival rates at 5 and 10 years were 94.2 ± 5.6% and 88.6% ± 10.3%, respectively. We conclude that improvement of symptoms, prevention of stroke, and stable long-term results justify surgical treatment in symptomatic patients with FMD of arteries supplying the brain.