The Correlation Between Wall Shear Stress and Plaque Composition in Advanced Human Carotid Atherosclerosis

Moerman, A. M.; Korteland, Suze-Anne; Dilba, Kristine; Gaalen, Kim van; Poot, Dirk H. J.; Lugt, Aad van der; Verhagen, Hence J.M.; Wentzel, Jolanda J.; Steen, Antonius F.W. van der; Gijsen, Frank; Heiden, Kim van der

doi:10.3389/fbioe.2021.828577

Cited by 29 publications

(13 citation statements)

References 50 publications

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“…Two different types of lesion formation were observed for the group with most significant flow disturbance and the one with the least severe flow disturbance. This finding is in agreement with a previous study, in which wall shear stress was shown to influence remodeling 44 , 45 . For group C (>90% ligation), more compliant vessels were observed.…”

Section: Discussionsupporting

confidence: 94%

Pulse wave and vector flow Imaging for atherosclerotic disease progression in hypercholesterolemic swine

Kemper

Karageorgos

Fodera

et al. 2023

Sci Rep

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Non-invasive monitoring of atherosclerosis remains challenging. Pulse Wave Imaging (PWI) is a non-invasive technique to measure the local stiffness at diastolic and end-systolic pressures and quantify the hemodynamics. The objective of this study is twofold, namely (1) to investigate the capability of (adaptive) PWI to assess progressive change in local stiffness and homogeneity of the carotid in a high-cholesterol swine model and (2) to assess the ability of PWI to monitor the change in hemodynamics and a corresponding change in stiffness. Nine (n=9) hypercholesterolemic swine were included in this study and followed for up to 9 months. A ligation in the left carotid was used to cause a hemodynamic disturbance. The carotids with detectable hemodynamic disturbance showed a reduction in wall shear stress immediately after ligation (2.12 ± 0.49 to 0.98 ± 0.47 Pa for 40–90% ligation (Group B) and 1.82 ± 0.25 to 0.49 ± 0.46 Pa for >90% ligation (Group C)). Histology revealed subsequent lesion formation after 8–9 months, and the type of lesion formation was dependent on the type of the induced ligation, with more complex plaques observed in the carotids with a more significant ligation (C: >90%). The compliance progression appears differed for groups B and C, with an increase in compliance to 2.09 ± 2.90×10−10 m2 Pa−1 for group C whereas the compliance of group B remained low at 8 months (0.95 ± 0.94×10−10 m2 Pa−1). In summary, PWI appeared capable of monitoring a change in wall shear stress and separating two distinct progression pathways resulting in distinct compliances.

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Section: Discussionsupporting

confidence: 94%

Pulse wave and vector flow Imaging for atherosclerotic disease progression in hypercholesterolemic swine

Kemper

Karageorgos

Fodera

et al. 2023

Sci Rep

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“…Atherosclerosis is thought of as subject to a triad of, and especially interactions among, systemic risk factors, haemodynamic forces, and the biological response of the wall ( 2 ). Atherosclerosis is related to systemic risk factors, which can be aggravated by lifestyle factors such as high caloric diet, physical inactivity, and smoking, but atherosclerosis is, in a sense, a geometrically focal disease ( 3 , 4 ). Plaque progression and eventually plaque rupture is influenced by a complex interaction between biological and haemodynamic factors ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Plaque progression and eventually plaque rupture is influenced by a complex interaction between biological and haemodynamic factors ( 5 ). The initiation of plaque formation has been strongly linked to a hemodynamic parameter: wall shear stress (WSS) ( 4 ). WSS is the frictional force exerted by flowing blood on the vessel wall, which significantly influences the evolution of atherosclerotic disease ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Wall shear stress and its role in atherosclerosis

Zhou

Chen

et al. 2023

Front. Cardiovasc. Med.

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Atherosclerosis (AS) is the major form of cardiovascular disease and the leading cause of morbidity and mortality in countries around the world. Atherosclerosis combines the interactions of systemic risk factors, haemodynamic factors, and biological factors, in which biomechanical and biochemical cues strongly regulate the process of atherosclerosis. The development of atherosclerosis is directly related to hemodynamic disorders and is the most important parameter in the biomechanics of atherosclerosis. The complex blood flow in arteries forms rich WSS vectorial features, including the newly proposed WSS topological skeleton to identify and classify the WSS fixed points and manifolds in complex vascular geometries. The onset of plaque usually occurs in the low WSS area, and the plaque development alters the local WSS topography. low WSS promotes atherosclerosis, while high WSS prevents atherosclerosis. Upon further progression of plaques, high WSS is associated with the formation of vulnerable plaque phenotype. Different types of shear stress can lead to focal differences in plaque composition and to spatial variations in the susceptibility to plaque rupture, atherosclerosis progression and thrombus formation. WSS can potentially gain insight into the initial lesions of AS and the vulnerable phenotype that gradually develops over time. The characteristics of WSS are studied through computational fluid dynamics (CFD) modeling. With the continuous improvement of computer performance-cost ratio, WSS as one of the effective parameters for early diagnosis of atherosclerosis has become a reality and will be worth actively promoting in clinical practice. The research on the pathogenesis of atherosclerosis based on WSS is gradually an academic consensus. This article will comprehensively review the systemic risk factors, hemodynamics and biological factors involved in the formation of atherosclerosis, and combine the application of CFD in hemodynamics, focusing on the mechanism of WSS and the complex interactions between WSS and plaque biological factors. It is expected to lay a foundation for revealing the pathophysiological mechanisms related to abnormal WSS in the progression and transformation of human atherosclerotic plaques.

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“…A study combining CFD with pathology found necrotic core size and macrophage area are significantly larger in areas exposed to high TAWSS. The vulnerability exhibited by CEUS was also not statistically different between the two groups [37]. Moreover, basic studies have demonstrated that higher WSS plays a crucial role in the expression of vascular endothelial growth factor and endothelial NO synthesis [38, 39], which is believed to be a major mechanism for neovascularization and increased endothelial permeability [40, 41].…”

Section: Discussionmentioning

confidence: 99%

Localized Elevation of Wall Shear Stress Is Linked to Recent Symptoms in Patients with Carotid Stenosis

et al. 2022

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Background: Estimation of symptomatic and asymptomatic carotid atherosclerosis differences can be the basis for prevention and management of carotid artery stenosis disease. In clinical practice, carotid plaque vulnerability is assessed only on the basis of luminal stenosis. However, the evolution of carotid plaque from an asymptomatic state to a symptomatic one is a complex process and the underlying hemodynamic mechanisms are unknown. We aimed to investigate the differences in hemodynamic parameters between patients with recently symptomatic carotid stenosis and asymptomatic ones. Methods: Hemodynamic simulations were performed on 26 carotid plaques from 25 patients with carotid artery stenosis ≥50%, 16 of whom had recent cerebrovascular ischemic events. Using human-specific flow parameters and 3D reconstruction of carotid computed tomography angiography images, we assessed hemodynamic characteristics such as wall shear stress (WSS), time-averaged WSS (TAWSS), oscillatory shear index, and relative residence time (RRT) during the cardiac cycle in patients with and without symptoms. Results: We found that symptomatic carotid stenosis patients had greater local TAWSS (99.59 ± 26.29 vs. 60.40 ± 20.46 dyn/cm2, p = 0.0007) and maximal WSS (116.65 ± 39.11 vs. 68.28 ± 23.67 dyn/cm2, p = 0.003), but lower RRT (0.019 ± 0.006 vs. 0.013 ± 0.069 s, p = 0.049), than asymptomatic patients, but this hemodynamic difference was not associated with carotid stenosis severity (p = 0.70). Patients with transient ischemic attack (TIA) or stroke had higher local TAWSS and WSSmax than patients with asymptomatic stenosis (p < 0.05). Subgroup analysis showed that there was no statistical difference in local hemodynamic variables between TIA and stroke patients with carotid artery stenosis. Conclusions: Patients with carotid artery stenosis are more likely to experience acute ischemic cerebrovascular accidents if they have higher WSS. Simultaneous assessment with hemodynamic parameters like WSS along with stenosis severity may aid risk stratification in patients with asymptomatic carotid artery stenosis.

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The Correlation Between Wall Shear Stress and Plaque Composition in Advanced Human Carotid Atherosclerosis

Cited by 29 publications

References 50 publications

Pulse wave and vector flow Imaging for atherosclerotic disease progression in hypercholesterolemic swine

Pulse wave and vector flow Imaging for atherosclerotic disease progression in hypercholesterolemic swine

Wall shear stress and its role in atherosclerosis

Localized Elevation of Wall Shear Stress Is Linked to Recent Symptoms in Patients with Carotid Stenosis

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