Intracoronary Shear Stress and CT Characteristics of Vulnerable Coronary Plaques

Abstract

Vulnerable coronary plaques are associated with a significant risk for rupture, and the ability to detect their characteristic features is of extreme importance, as timely detection of rupture-prone plaques could lead to the appropriate initiation of adequate therapeutic measures and prevent the evolution to an acute coronary event. The most common features of vulnerability in coronary plaques are represented by the presence of low density atheroma, a thin fibrous cap, spotty calcifications, and positive remodeling. However, there is still a huge amount of information to be learned about the role of local forces, represented by the shear stress, on the plaque vulnerability. This clinical update aims to present the most recent advances in the field of knowledge regarding the relation between shear stress and plaque vulnerability, starting from the hypothesis that shear stress significantly correlates with the CT features of plaque vulnerability and can represent a new marker of vulnerability in coronary artery plaques.Keywords: shear stress, computed tomography angiography, plaque vulnerability Recently, noninvasive diagnostic methods, especially the computed tomography (CT) angiography, have received an increasingly important role in the prevention of cardiac diseases. The role of CT is even more crucial in the determination of CT-based plaque-vulnerability factors. The most important CT vulnerability markers at this time are the volume of low density atheroma, the plaque burden, the thin fibrous cap, and the positive remodeling. [1][2][3][4] So the main question today remains: is it possible to define a new vulnerability marker based on the CT images, and, more importantly, would it be possible for shear stress to become that new vulnerability marker?It is known that shear stress plays an important role in the development of atherosclerosis, 5-7 through complex processes that are more and more better known with the help of computer fluid dynamics. [8][9][10][11][12] There were also several successful attempts of finding the correlation between shear stress and other vulnerability factors, defined by the use of invasive imagUnauthenticated Download Date | 5/12/18 9:06 AM

Association of Coronary Wall Shear Stress With Atheromatous Plaque Vulnerability: A Systematic Review

“…Several recent studies identified areas with low ESS in the close vicinity of unstable coronary plaques [32]. At the same time, other studies suggested that rather than the low ESS, the high ESS could represent the factor triggering plaque vulnerability.…”