A 59-year-old Chinese patient was diagnosed with fibromuscular dysplasia (FMD) which is a rare genetic disorder among Asians. Neck vessels angiography showed a classic ''string of bead appearance'' affecting vertebral and internal carotid arteries. Carotid artery surgical reconstruction and vertebral intervention were proposed by vascular surgeon to prevent future strokes, but patient's family refused for intervention/surgery. However, on optimal medical management his health improved during follow-up of over 8 months. This case shows unique multivessel FMD involving bilateral vertebral and one internal carotid artery which was managed successfully with medical management.