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Theme: Vascular Disease & Stroke - Review

Biomechanical structural stresses of atherosclerotic plaques

Umar Sadat University Department of Radiology, Box 218, Level 5, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. [email protected]; Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. [email protected]

,

Zhongzhao Teng University Department of Radiology, Box 218, Level 5, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK; University Department of Radiology, Box 218, Level 5, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

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Jonathan H Gillard University Department of Radiology, Box 218, Level 5, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK; University Department of Radiology, Box 218, Level 5, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

Abstract

Atherosclerotic plaques may rupture without warning, causing fatal clinical events such as myocardial infarction and stroke. Degree of stenosis, which is the current criterion for assessment of atherosclerotic disease severity, has been observed to have poor correlation with plaque vulnerability. Under physiological conditions, plaque undertakes mechanical loadings due to blood pressure and flow. From the material view point, rupture possibly occurs when the extra loading exceeds the material strength of the plaque. Therefore, morphological and mechanical features should be considered in an integrated way for a more accurate assessment of plaque vulnerability and for identification of the at-risk patient. Biomechanical stress analysis is a technique that allows such comprehensive assessment. This article focuses on the mechanical stresses in the plaque structure, which are believed to be of greater magnitude than the associated wall shear stress and are thought to be more closely associated with plaque rupture. We discuss the basic mechanics that govern plaque behavior, the material properties of atherosclerotic tissues and the studies investigating the association between high biomechanical stresses and plaque rupture. Parameter studies investigating the effect of morphologic factors on the critical biomechanical stresses and limitations of current simulation models are also reviewed.

Keywords::

Financial & competing interests disclosure

This article is partly supported by ARTreat European Union FP7 and NIHR Cambridge Biomedical Research Centre. Umar Sadat is supported by a Medical Research Council UK and Royal College of Surgeons of England Joint Clinical Research Training Fellowship. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

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