A 35-year-old woman has hypertension refractory to three drugs. She is found to have fibromuscular dysplasia of the renal artery on CT angiography (multifocal 'string-of-beads' pattern). What is the most appropriate revascularization strategy?

• A Surgical revascularization (bypass grafting)
• B Renal artery stenting
• C Percutaneous transluminal renal angioplasty (PTRA) without stenting ✓
• D Nephrectomy of the affected kidney

Explanation

Percutaneous transluminal angioplasty (PTRA) without stenting is the treatment of choice for fibromuscular dysplasia (FMD) of the renal artery. Unlike atherosclerotic renal artery stenosis (where stenting improves technical results), FMD responds excellently to balloon angioplasty alone with cure or substantial improvement in hypertension in 50–60% and technical success >90%. Stenting is reserved for refractory cases or post-angioplasty dissection. Surgical bypass is used only when angioplasty fails. The 2017 AHA Scientific Statement on FMD endorses PTRA as first-line revascularization.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.