Longitudinal distribution of mechanical stresses in carotid plaques of symptomatic patients.
OBJECTIVE
Mechanical stress may contribute to plaque rupture in patients with carotid atherosclerosis. We determined longitudinal mechanical stresses in carotid atherosclerotic plaques and compared them with known markers of plaque vulnerability.


METHODS
Nineteen symptomatic patients scheduled for carotid endarterectomy underwent carotid MRI with a multicontrast protocol to characterize plaque morphology and geometry. Longitudinal 2-dimensional computational models were generated from the MRI data, and the mechanical stresses were calculated.


RESULTS
Peak longitudinal mechanical stresses occurred predominantly in the shoulder regions of the carotid plaque and correlated inversely with fibrous cap thickness (r(s)=-0.61; P=0.01), and increasing degrees of stenosis (r(s)=0.71; P=0.003). Peak stress levels were asymmetrically distributed longitudinally, with 50% occurring proximal to the maximal stenosis, 25% at the point of maximal stenosis, and 25% distal to the maximal stenosis.


CONCLUSIONS
The peak longitudinal mechanical stresses in the fibrous caps of symptomatic patients with carotid atherosclerotic stenosis were located at known predilection sites for plaque rupture, suggesting that mechanical stresses may play a role in plaque destabilization.
Aarhus University Hospital Skejby, MR-Center, Brendstrupgaardsvej 100, DK-8200, Aarhus N, Denmark. Samuel@mr.au.dk
Samuel A
SA
Thrysøe
Minako
M
Oikawa
Chun
C
Yuan
Nikolaj
N
Eldrup
Anette
A
Klaerke
William P
WP
Paaske
Erling
E
Falk
W Yong
WY
Kim
Jens Vinge
JV
Nygaard
D002340:Carotid Artery Diseases / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008955:Models, Cardiovascular; D013314:Stress, Mechanical