3D critical plaque wall stress is a better predictor of carotid plaque rupture sites than flow shear stress: An in vivo MRI-based 3D FSI study.
Atherosclerotic plaque rupture leading to stroke is the major cause of long-term disability as well as the third most common cause of mortality. Image-based computational models have been introduced seeking critical mechanical indicators, which may be used for plaque vulnerability assessment. This study extends the previous 2D critical stress concept to 3D by using in vivo magnetic resonance image (MRI) data of human atherosclerotic carotid plaques and 3D fluid-structure interaction (FSI) models to: identify 3D critical plaque wall stress (CPWS) and critical flow shear stress (CFSS) and to investigate their associations with plaque rupture. In vivo MRI data of carotid plaques from 18 patients scheduled for endarterectomy were acquired using histologically validated multicontrast protocols. Of the 18 plaques, histology-confirmed that six had prior rupture (group 1) as evidenced by presence of ulceration. The remaining 12 plaques (group 2) contained no rupture. The 3D multicomponent FSI models were constructed for each plaque to obtain 3D plaque wall stress (PWS) and flow shear stress (FSS) distributions. Three-dimensional CPWS and CFSS, defined as maxima of PWS and FSS from all vulnerable sites, were determined for each plaque to investigate their association with plaque rupture. Slice-based critical PWS and FSS were also calculated for all slices for more detailed analysis and comparison. The mean 3D CPWS of group 1 was 263.44 kPa, which was 100% higher than that from group 2 (132.77, p=0.03984). Five of the six ruptured plaques had 3D CPWS sites, matching the histology-confirmed rupture sites with an 83% agreement. Although the mean 3D CFSS (92.94 dyn/cm(2)) for group 1 was 76% higher than that for group 2 (52.70 dyn/cm(2)), slice-based CFSS showed no significant difference between the two groups. Only two of the six ruptured plaques had 3D CFSS sites matching the histology-confirmed rupture sites with a 33% agreement. CFSS had a good correlation with plaque stenosis severity (R(2)=0.40 with an exponential function fitting 3D CFSS data). This in vivo MRI pilot study using plaques with and without rupture demonstrates that 3D critical plaque wall stress values are more closely associated with atherosclerotic plaque rupture then critical flow shear stresses. Critical wall stress values may become indicators of high risk sites of rupture. Future work with a larger population will establish a possible CPWS-based plaque vulnerability classification.
Teng
Zhongzhao
Z
Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA.
Canton
Gador
G
Yuan
Chun
C
Ferguson
Marina
M
Yang
Chun
C
Huang
Xueying
X
Zheng
Jie
J
Woodard
Pamela K
PK
Tang
Dalin
D
D000368:Aged; D002339:Carotid Arteries / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000503:physiopathology*; D003198:Computer Simulation; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008955:Models, Cardiovascular; D010865:Pilot Projects; D012212:Rheology / Q000379:methods; D033081:Shear Strength; D013314:Stress, Mechanical
Ann Biomed Eng. 2002 Jun;30(6):753-67
12220076
J Biomech Eng. 2009 Jun;131(6):061010
19449964
Biomed Eng Online. 2009 Aug 03;8:15
19650901
Radiology. 2001 Nov;221(2):285-99
11687667
Stroke. 2009 Oct;40(10):3258-63
19628799
Ann Biomed Eng. 2004 Jul;32(7):947-60
15298432
Stroke. 2008 Aug;39(8):2341-7
18556585
J Am Coll Cardiol. 2008 Feb 12;51(6):645-50
18261684
Arterioscler Thromb Vasc Biol. 2005 Jan;25(1):234-9
15528475
Circ Res. 1992 Oct;71(4):850-8
1516158
Mol Cell Biomech. 2008 Mar;5(1):9-18
18524242
J Biomech Eng. 2009 Jun;131(6):061013
19449967
J Biomech Eng. 2004 Oct;126(5):657-65
15648819
Circulation. 2006 Mar 28;113(12):e660-1
16567574
J Biomech. 2006;39(14):2611-22
16256124
J Magn Reson Imaging. 2000 Mar;11(3):299-311
10739562
Circulation. 2003 Apr 29;107(16):2072-5
12719287
Med Biol Eng Comput. 2008 Nov;46(11):1097-112
19002516
Circulation. 2003 Nov 18;108(20):2542
14623792
Circulation. 2000 Aug 29;102(9):959-64
10961958
J Biomech Eng. 2005 Dec;127(7):1185-94
16502661
Arteriosclerosis. 1985 May-Jun;5(3):293-302
3994585
Ann Biomed Eng. 2002 Apr;30(4):483-97
12086000
Atherosclerosis. 1987 Nov;68(1-2):27-33
3689481
Circulation. 2002 Jan 15;105(2):181-5
11790698
Proc Natl Acad Sci U S A. 2006 Oct 3;103(40):14678-83
17003118
Cerebrovasc Dis. 2003;16(4):369-75
13130178
Ann Biomed Eng. 2005 Dec;33(12):1789-801
16389527
Circulation. 2001 Oct 23;104(17):2051-6
11673345
J Magn Reson Imaging. 2003 Apr;17(4):410-20
12655579
Int J Cardiol. 2009 Jun 12;135(1):43-52
18597872
Ann Biomed Eng. 2004 Jul;32(7):932-46
15298431
Circulation. 2002 Sep 10;106(11):1368-73
12221054
J Biomech. 2004 Nov;37(11):1767-75
15388320
Circulation. 1993 Apr;87(4):1179-87
8462145
Comput Model Eng Sci. 2007 Jan 1;19(3):233-246
19784387
Atherosclerosis. 2007 Oct;194(2):e34-42
16978632
Top Magn Reson Imaging. 2007 Oct;18(5):371-8
18025991
J Cardiovasc Risk. 2002 Oct;9(5):229-35
12394315