Abstract
Plaque rupture occurs if stress within coronary lesions exceeds the protection exerted by the fibrous cap overlying the necrotic lipid core. However, very little is known about the biomechanical stress exerting this disrupting force. Employing optical coherence tomography (OCT), we generated plaque models and performed finite-element analysis to simulate stress distributions within the vessel wall in 10 ruptured and 10 non-ruptured lesions. In ruptured lesions, maximal stress within fibrous cap (peak cap stress [PCS]: 174 ± 67 vs. 52 ± 42 kPa, p<0.001) and vessel wall (maximal plaque stress [MPS]: 399 ± 233 vs. 90 ± 95 kPa, p=0.001) were significantly higher compared to non-ruptured plaques. Ruptures arose in the immediate proximity of maximal stress concentrations (angular distances: 21.8 ± 30.3° for PCS vs. 20.7 ± 23.7° for MPS); stress concentrations excellently predicted plaque rupture (area under the curve: 0.940 for PCS, 0.950 for MPS). This prediction of plaque rupture was superior to established vulnerability features such as fibrous cap thickness or macrophage infiltration. In conclusion, OCT-based finite-element analysis effectively assesses plaque biomechanics, which in turn predicts plaque rupture in patients. This highlights the importance of morpho-mechanic analysis assessing the disrupting effects of plaque stress.
Highlights
Coronary artery disease (CAD) is one of the major causes of morbidity and mortality in the Western World (Center for Disease Control, 2013)
We aimed to analyze the spatial correlation between the rupture point, as visualized in optical coherence tomography (OCT) images, and the point of maximal stress concentration, in order to further support the mechanistic role of stress concentrations in the fibrous cap in the genesis of plaque rupture
As a further step in confirming this theory, we extended current knowledge by showing that plaque ruptures arise in the immediate proximity of maximal stress concentrations
Summary
Coronary artery disease (CAD) is one of the major causes of morbidity and mortality in the Western World (Center for Disease Control, 2013). The presently accepted features assessed using intravascular imaging include the thickness of the fibrous cap (FCT) (Kato et al, 2012; Kubo et al, 2013; Reith et al, 2014; Uemura et al, 2012), the extent of the necrotic lipid core (Kato et al, 2012), the presence of macrophages (Kato et al, 2012; Reith et al, 2014; Uemura et al, 2012), microvessels (Kato et al, 2012; Uemura et al, 2012), small calcifications
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