Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular condition that leads to abnormal arterial wall development and can predispose individuals to vascular complications such as dissection and aneurysm formation. While FMD is detected in 6% to 14% of patients with SCEAD, its exact role in disease recurrence has remained unclear.
To address this, researchers analyzed data from the Stroke Prevention in Cervical Artery Dissection (STOP-CAD) retrospective cohort, which included 3,714 adults diagnosed with SCEAD across 63 centers in 16 countries between 2015 and 2022. The study compared patients with and without FMD to assess differences in demographics, clinical presentation, imaging findings, and recurrence rates over 24 months.
The study led to the following findings:
- Among the study population, 196 patients (5.3%) had fibromuscular dysplasia.
- Patients with FMD were generally older and predominantly female compared with those without FMD.
- They more often had a history of dissections in arteries other than the cervical arteries, previous SCEAD, recent upper respiratory tract infection, cerebral aneurysm, or migraines.
- Imaging findings showed that FMD patients were less likely to have a single vertebral artery dissection or an occlusive dissection, suggesting distinct radiological characteristics.
- During follow-up, 81 participants experienced recurrent SCEAD, with more than half of these cases occurring within the first three months.
- The 24-month recurrence rate was 7.7% in patients with FMD versus 2.8% in those without FMD.
- This reflects a 2.75-fold higher risk of recurrence among patients with FMD.
The researchers emphasized that recognizing FMD in patients with SCEAD is critical for risk stratification and clinical management. Identifying FMD-related markers—such as migraine history, previous dissections, or associated aneurysms—may help clinicians tailor follow-up strategies and patient counseling.
However, the authors acknowledged certain limitations. The original STOP-CAD study was not specifically designed to investigate FMD, and data on some variables, such as detailed imaging protocols, vascular distribution, and family history, were unavailable. Moreover, the study focused on short- to medium-term outcomes, and longer follow-up data are needed to fully understand the long-term recurrence risk.
"The large, international cohort study reinforces that FMD is an important risk factor for recurrent spontaneous cervical artery dissection. The findings suggest that FMD should be actively considered in patients with cervical artery dissection—particularly those with suggestive clinical or imaging features—to improve diagnosis, monitoring, and long-term management," the authors concluded.
Reference:
Nehme A, Shu L, Boulanger M, et al. Fibromuscular Dysplasia and Spontaneous Cervical Artery Dissection. JAMA Netw Open. 2025;8(11):e2540800. doi:10.1001/jamanetworkopen.2025.40800
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