OCT Made Easy by Hiram G. Bezerra & Guilherme F. Attizzani & Marco A. Costa

Author:Hiram G. Bezerra & Guilherme F. Attizzani & Marco A. Costa [Bezerra, Hiram G.]
Language: eng
Format: azw3
ISBN: 9781351667678
Publisher: CRC Press
Published: 2017-10-12T04:00:00+00:00

7.1.3Fibromuscular dysplasia

FMD is a segmental nonatherosclerotic, noninflammatory vasculopathy of the small to medium-sized arteries that can affect all layers of the vessel wall. Historically, FMD was classified histologically into intimal fibroplasia, medial fibroplasia (correlating with the angiographic string of beads appearance), perimedial fibroplasia, and adventitial fibroplasia.19,20 Case reports have demonstrated severe disorganization of the ultrastructure of the arterial wall with alternating areas of smooth muscle cell hyperplasia and adventitial collagen deposition with loss of the anatomical boundaries of the elastic lamellae, all contributing to severe luminal obstruction. The first case of coronary FMD associated with SCAD was reported in 1987 by autopsy.19 Multiple case reports, including our own, have since implicated coronary FMD as a central predisposing arteriopathy in the pathogenesis of SCAD.11,19,21–27 Interestingly, intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has the ability to document areas of bright, echogenic and reflective collagen interspersed with areas of cellular hyperplasia (Figure 7.1), similar to the histological descriptions of FMD.24

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