A 28-year-old woman presents with severe hypertension (210/120 mmHg) refractory to three medications. Abdominal examination reveals a bruit over the left flank. CT angiography shows a string-of-beads appearance in the mid-renal artery. Which is the most appropriate definitive management?
- A Percutaneous transluminal renal angioplasty without stenting ✓
- B Aortorenal bypass surgery
- C Optimal medical therapy with ACE inhibitor and calcium channel blocker
- D Renal artery stenting with drug-eluting stent
Correct answer: A. Percutaneous transluminal renal angioplasty without stenting
Explanation
The string-of-beads appearance is pathognomonic for fibromuscular dysplasia (FMD), the most common cause of renovascular hypertension in young women. Percutaneous transluminal angioplasty (without stenting) is the preferred revascularization for FMD and achieves cure or improvement in most patients. Stenting is reserved for atherosclerotic disease or failed angioplasty. Medical therapy alone does not correct the underlying hemodynamic lesion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.