Fibromuscular dysplasia (FMD) is increasingly recognized as a nonatherosclerotic pathology in young women presenting with acute coronary syndromes. The angiographic appearance of these lesions may mimic typical atherosclerosis, and a high index of suspicion is needed. The pathophysiological changes in the intima and media alter the vessel's elasticity and may adversely affect the lesion's response to balloon dilatation and stenting. Intracoronary imaging is therefore useful when planning percutaneous intervention. We present a case of stent implantation in a coronary FMD lesion complicated by perforation with intravascular ultrasound images demonstrating the typical changes of FMD.
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