This protocol covers renal artery fibromuscular dysplasia in patients where hypertension is the presenting concern — a specific clinical scenario with defined intervention and blood-pressure goals.
Hypertension is the most frequent presenting symptom in patients with renal fibromuscular dysplasia. This protocol applies to renal artery FMD where hypertension drives the clinical decision.
Treatment involves a percutaneous approach directed at the affected renal artery. The primary goal is cure of hypertension — blood pressure below 140/90 mmHg without ongoing antihypertensive medication.
Complete procedural algorithm and decision criteria available in the full protocol below ↓Hypertension is, by far, the most frequent presenting symptom among patients with renal FMD, whereas headache (especially migraine), pulsatile tinnitus, transient ischemic attack (TIA) or stroke may be the hallmark of cerebrovascular FMD.
Accordingly, in the absence of the demonstrated added value of stenting, angioplasty alone is the revascularization approach of choice for renal artery FMD, and stenting is reserved for the treatment of procedural complications, such as a flow-limiting dissection or arterial rupture.
In a meta-analysis by Trinquart and colleagues, the rate of cure of hypertension (defined as blood pressure < 140/90 mmHg without medication) was only 36% after angioplasty across 11 clinical studies (range 14–85%), with the probability of being cured associated with younger patient age at the time of treatment and shorter duration of hypertension.
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