Abstract 15794: Role of Endothelial Shear Stress and Endothelial Shear Stress Gradient in Plaques Associated With Acute Erosion vs. Stable Control Plaques

Abstract

Introduction: The role of endothelial shear stress (ESS) in the natural history of plaque growth and TCFA formation/destabilization has been studied, but the role in plaque erosion is unknown. High ESS gradient (ESSG) has been hypothesized to promote plaque erosion, but no studies have included matched “control” stable plaques with the same minimal luminal area (MLA) and reference luminal area (RLA) but no adverse coronary event. Hypothesis: To compare ESS and ESSG between coronary plaques that developed erosion and similar morphology plaques that remain stable. Methods: We studied a subset of patients from both TOTAL and COMPLETE trials who underwent angiography and OCT evaluation: 27 patients (27 arteries: 18 LAD, 3 LCX, 6 RCA). Plaques were divided into Plaque Erosion (n=16) from TOTAL study with OCT features of plaque erosion and Control (n=11) plaques (non-culprit lesions from COMPLETE) with matched MLA and RLA and no OCT evidence of plaque disruption. Orthogonal angiographic views were used to generate a 3-D arterial reconstruction, and angio centerline was merged with OCT centerline. Local ESS distribution was assessed by computational flow dynamics and reported in consecutive 3-mm segments. Results: Table 1 shows differences in ESS between Plaque Erosion and Control Plaques Conclusions: In coronary plaques with similar severe obstruction (MLA) and reference area (RLA), plaque erosion is associated with higher coronary flow, max ESS, and ESSG in any direction, in the proximal-to-distal direction, and in the circumferential direction compared to plaques that remain stable. Future studies will determine which "feature (s)" of high ESS or ESSG are independently associated with erosion.