FIBROMUSCULAR hyperplasia is an intrinsic arterial lesion which often has a characteristic "string of beads" appearance on angiograms. Most commonly found in the renal arteries of young and middle aged female patients, it is felt to be the most common form of several related conditions, including periarterial fibrous stenosis and internal fibrous stenosis and classified under the term "fibrous dysplasia." Harrison et al1 describe them as a group of related idiopathic nonarteriosclerotic arterial lesions producing disruptive and hyperplastic changes in the arterial wall, particularly involving the elastica, smooth muscle, and fibrous elements of the media, which result in various types of stenosis with or without aneurysm.
The relative infrequency of fibromuscular hyperplasia in the cranial vessels is reflected by the finding of Houser and Baker2 of 16 cases in 5,000 angiograms. In fact, there have only been a few reports of the disease in the carotid arteries
Kaufman HH. Fibromuscular Hyperplasia of the Carotid Artery: In a Case Associated With an Arteriovenous Malformation. Arch Neurol. 1970;22(4):299–304. doi:10.1001/archneur.1970.00480220013003
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