Fibromuscular Dysplasia and Cerebrovascular Dissection: Insights From a Multicenter Cohort

• This multicenter, retrospective cohort analyzes patients with both spontaneous cervical artery dissection (SCeAD) and fibromuscular dysplasia (FMD) across three comprehensive stroke centers in the United States from 2018 to 2023.
• Identification relied on hospital records and vascular registries, with imaging reviews by vascular neurologists or cardiologists to confirm FMD and SCeAD diagnoses.
• Primary outcomes encompassed recurrent dissections, cardiovascular events (ischemic stroke, transient ischemic attack, myocardial infarction, subarachnoid hemorrhage), and mortality.

• Among 1,632 individuals with SCeAD, 97 carried a diagnosis of FMD, representing 6% of the SCeAD cohort.
• The cohort showed a strong female predominance (approximately 91%), with a median age at FMD diagnosis of 50 years (interquartile range 42–63).
• Carotid dissections predominated over vertebral dissections (86% vs 27%), and a substantial subset experienced multiple dissections (33% of patients).
• Among those with multiple dissections, bilateral involvement accounted for 75%, recurrent dissections in the same artery occurred in 13%, and dissections extended to other vascular beds (renal, iliac, mesenteric, or coronary arteries) were observed in 22%.

• Younger age was associated with a higher likelihood of multiple dissections (odds ratio 0.945 per year; 95% CI 0.908–0.983; P = 0.005).
• Classical FMD “beading” on imaging correlated with multiple dissections (OR 3.06; 95% CI 1.28–7.36; P = 0.012).
• Aneurysm presence appeared more frequently in patients with multifocal disease (27% overall; OR 1.66; 95% CI 1.02–2.71; P = 0.04).

Anticoagulation was used in 22%, with no significant differences in event rates across these treatment groups reported in the study.

Over this period, recurrent dissections occurred in 13% of patients, and cardiovascular events developed in 28%.

• Antithrombotic strategies at discharge were diverse: most patients received single antiplatelet therapy (approximately 49%), while 29% were on dual antiplatelet therapy.
• Follow-up averaged 5 years (±2.5 years).
• Recurrent dissections carried a markedly higher association with subsequent cardiovascular events (odds ratio 11.56; 95% CI 2.22–60.07; P = 0.004).

• The findings indicate that FMD is a relevant consideration in patients with SCeAD, especially in middle-aged women presenting with multifocal dissections and an absence of traditional vascular risk factors.
• There is an observable uptick in recurrence risk and in harboring aneurysms for this subgroup, alongside an elevated likelihood of future cardiovascular events after recurrent dissections.