Biomechanical stress in coronary atherosclerosis: emerging insights from computational modelling

Abstract

Coronary plaque rupture is the most common cause of vessel thrombosis and acute coronary syndrome. The accurate early detection of plaques prone to rupture may allow prospective, preventative treatment; however, current diagnostic methods remain inadequate to detect these lesions. Established imaging features indicating vulnerability do not confer adequate specificity for symptomatic rupture. Similarly, even though experimental and computational studies have underscored the importance of endothelial shear stress in progressive atherosclerosis, the ability of shear stress to predict plaque progression remains incremental. This review examines recent advances in image-based computational modelling that have elucidated possible mechanisms of plaque progression and rupture, and potentially novel features of plaques most prone to symptomatic rupture. With further study and clinical validation, these markers and techniques may improve the specificity of future culprit plaque detection.

Association of stent‐induced changes in coronary geometry with late stent failure: Insights from three‐dimensional quantitative coronary angiographic analysis

“…The local flow alterations, especially the low ESS pattern corresponding to the vessel geometry change might mediate biological responses through increased thrombogenicity and impaired rate of vascular repair . In addition, low ESS promotes smooth muscle cell (SMC) proliferation and migration, the expression of proteins that perpetuate inflammation and lipid accumulation and can transform the benign neointima to a vulnerable plaque . Therefore, stented lesions that are exposed to low ESS exhibit augmented neoatherosclerosis and neointimal hyperplasia.…”

“…whereas the inner regions have a lower ESS [22]. [27][28][29]. Therefore, stented lesions that are exposed to low ESS exhibit augmented neoatherosclerosis and neointimal hyperplasia.…”

Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds

“…11 The unsteady nature of arterial blood flow determines the endothelial shear stress in combination with the geometric vessel configuration, being characterized by direction and magnitude. In regions with irregular geometry, a disturbed laminar flow appears, and the pulsatile flow shows oscillatory endothelial shear stress.…”

Implications of the local haemodynamic forces on the phenotype of coronary plaques

“…Numerous histology and in vivo studies have shown that local haemodynamic forces and in particular the endothelial shear stress (ESS) are instigators of plaque formation and of the development of high-risk vulnerable plaques 1. Clinical reports have explored the implications of plaque morphology and of ESS on atherosclerotic disease progression,2 and experimental studies have examined the effect of ESS in lesions with a high-risk phenotype3; however, there is limited clinical data about the implications of ESS on the dynamic changes in plaque phenotype.…”