title: Multi-Layer Mechanical Model of Glagov Remodeling in Coronary Arteries: Differences between In-Vivo and Ex-Vivo Measurements.
abstract: When blood vessels undergo remodeling because of the buildup of atherosclerotic plaque, it is thought that they first undergo compensatory or outward remodeling, followed by inward remodeling: the lumen area stays roughly constant or increases slightly and then decreases rapidly. The second phase of remodeling is supposed to start after the plaque burden exceeds about 40%. These changes in the vessel were first observed by S. Glagov who examined cross-sections of coronary arteries at different stages of the disease. In this paper, we use a mathematical model based on growth and elasticity theory to verify the main aspects of Glagov's result. However, both our model and curve-fitting to the data suggest that the critical stenosis is around 20% rather than 40%. Our model and data from the PROSPECT trial also show that Glagov remodeling is qualitatively different depending on whether measurements are taken ex-vivo or in-vivo. Our results suggest that the first outward phase of "Glagov remodeling" is largely absent for in-vivo measurements: that is, the lumen area always decreases as plaque builds up. We advocate that care must be taken when infering how in-vivo vessels remodel from ex-vivo data.
authors.affiliation: Department of Mathematical Sciences, University of Delaware, Newark, DE 19716, United States of America.
authors.forename: Pak-Wing
authors.initials: PW
authors.lastname: Fok
mesh_terms: D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000473:pathology*; D001344:Autopsy; D003198:Computer Simulation; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008955:Models, Cardiovascular; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology*