Renal Artery Fibromuscular Dysplasia With Hypertension: When Balloon Angioplasty Has Not Achieved Blood Pressure Cure

Clinical Scenario

This protocol addresses renal artery fibromuscular dysplasia presenting with hypertension in patients where a prior percutaneous intervention did not achieve the target of blood pressure normalisation without medication.

Previous Treatment — Target Not Reached

Percutaneous balloon angioplasty of the renal artery (with renal artery stenting reserved for procedural complications such as flow-limiting dissection or arterial rupture) was performed but did not achieve cure of hypertension — sustained blood pressure below 140/90 mmHg without antihypertensive medication.

About the Condition

Hypertension is the most frequent presenting symptom among patients with renal fibromuscular dysplasia. Durable blood pressure control in this setting depends on successful restoration of renal artery anatomy.

Next-Line Treatment Approach

A surgical revascularisation strategy is considered in selected patients — particularly those with complex lesion anatomy or following failure of prior angioplasty. The complete eligibility criteria, procedural details, and post-procedural management are defined in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

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.

Surgery remains the primary approach in rare patients with complex FMD lesions of the arterial bifurcation or branches, stenoses associated with complex aneurysms, or following failure of angioplasty.

DOI: 10.1177/1358863X18821816

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