High Wall Shear Stress Is Related to Atherosclerotic Plaque Rupture in the Aortic Arch of Patients with Cardiovascular Disease: A Study with Computational Fluid Dynamics Model and Non-Obstructive General Angioscopy

Abstract

Wall shear stress (WSS) has been considered a major determinant of aortic atherosclerosis. Recently, nonobstructive general angioscopy (NOGA) was developed to visualize various atherosclerotic pathologies, including in vivo ruptured plaque (RP) in the aorta. However, the relationship between aortic RP and WSS distribution within the aortic wall is unclear. This study aimed to investigate the relationship between aortic NOGA-derived RP and the stereographic distribution of WSS by computational fluid dynamics (CFD) modeling using threedimensional computed tomography (3D-CT) angiography. Methods:We investigated 45 consecutive patients who underwent 3D-CT before coronary angiography and NOGA during coronary angiography. WSS in the aortic arch was measured by CFD analysis based on the finite element method using uniform inlet and outlet flow conditions. Aortic RP was detected by NOGA.Results: Patients with a distinct RP showed a significantly higher maximum WSS value in the aortic arch than those without aortic RP (56.2 30.6 Pa vs 36.2 19.8 Pa, p 0.017), no significant difference was noted in the mean WSS between those with and without aortic RP. In a multivariate logistic regression analysis, the presence of a maximum WSS value more than a specific value was a significant predictor of aortic RP (odds ratio 7.21, 95% confidence interval 1.78-37.1, p 0.005).Conclusions: Aortic RP detected by NOGA was strongly associated with a higher maximum WSS in the aortic arch derived by CFD using 3D-CT. The maximum WSS value may have an important role in the underlying mechanism of not only aortic atherosclerosis, but also aortic RP. vessel wall. Since WSS is involved in the endothelial function, WSS significantly influences site-specific susceptibility and progression of atherosclerosis 2) . Regarding the coronary artery, previous studies have suggested that WSS affects local plaque morphology or vulnerability 3,4) and its progression 5

Junctional Adhesion Molecules: Potential Proteins in Atherosclerosis

“…Chronically low oscillating WSS is most susceptible to causing local AS. However, stenosis-induced high WSS pushes plaque rupture ( 159 , 160 ). As several of above mentioned AS-related events such as vascular inflammation, disruption of endothelial barrier, and angiogenesis are closed related to flow-induced shear stress, we made a separate summary in this section.…”

2D Projection Maps of WSS and OSI Reveal Distinct Spatiotemporal Changes in Hemodynamics in the Murine Aorta during Ageing and Atherosclerosis

“…A lower SMC-derived collagen content within plaques may thus be in line with increased longWSS. Importantly, increased WSS values were reported to be associated with plaque rupture [ 37 ], whereas vortices causing oscillatory shear stress induce more stable plaques with higher SMC and collagen content [ 32 , 33 ].…”

Serial Changes of Aortic Vulnerable Plaques Observed via Non-Obstructive General Angioscopy

“…Following the PCI, NOGA for the coronary artery and aorta was performed. NOGA showed 2-degree yellow plaque without red thrombus at the stent site (Figure 1A) and a puffchandelier rupture (PCR), a vulnerable type of atheromatous plaque, [7][8][9][10][11] on the distal aortic arch (Figures 2A, 3A, Figure 4A; red arrow). The PCR observed by NOGA showed the scattering of atheromatous materials from the ruptured plaques by blood flow, and mobile plaque contents were also observed (Figure 3A).…”