Fibromuscular Dysplasia and Cerebrovascular Dissection: Insights From a Multicenter Cohort

10 Mar 20264 min read0 viewsJournal Feed

GIST (Key Takeaways)

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. Background. Fibromuscular dysplasia (FMD) is a noninflammatory arteriopathy that may result in arterial stenosis, dissection, aneurysm, and tortuosity. Data remain limited on clinical features and outcomes of patients with FMD presenting with spontaneous cervical artery dissection (SCeAD).
This study aimed to describe the characteristics and long‐term outcomes of this population. Methods. We conducted a retrospective multicenter cohort study of patients diagnosed with both SCeAD and FMD at 3 US comprehensive stroke centers (2018–2023). Patients were identified through hospital records and vascular registries.
Diagnosis of FMD and SCeAD was confirmed through imaging review by vascular neurologists or cardiologists. Outcomes included recurrent dissections, cardiovascular events (ischemic stroke, transient ischemic attack, myocardial infarction, subarachnoid hemorrhage) and mortality. Results. Among 1632 patients with SCeAD, 97 (6%) had FMD diagnosis.
The cohort was predominantly female (91%) and median age at FMD diagnosis was 50 years (interquartile range, 42–63). Carotid dissections were more frequent than vertebral dissections (86% versus 27%,P<0.001).

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.