Fibromuscular dysplasia of the internal carotid artery: its occurrence with acute stroke and its surgical reversal.

A case of fibromuscular dysplasia (FMD) of the internal carotid artery that caused acute stroke was successfully treated, with total removal of the FMD rings along with their attached thrombus without segmental excision of the artery. The natural history of this disease is unknown, which raises a concern in management of the many patients with FMD who are asymptomatic. Transient ischemic attack and repeated strokes may be attributable to embolic phenomenon of the thrombus or to platelet aggregates from the FMD segment of the artery. The FMD syndrome can appear as an acute stroke in the young age group. Symptomatic lesions have been managed by excision and arterial reconstruction, by patch angioplasty, or by dilation alone. To our knowledge, this is the first report of total removal of FMD rings without segmental excision of the artery.