Abstract
Background and aimsCarotid artery plaques with vulnerable plaque components are related to a higher risk of cerebrovascular accidents. It is unknown which factors drive vulnerable plaque development. Shear stress, the frictional force of blood at the vessel wall, is known to influence plaque formation. We evaluated the association between shear stress and plaque components (intraplaque haemorrhage (IPH), lipid rich necrotic core (LRNC) and/or calcifications) in relatively small carotid artery plaques in asymptomatic persons. MethodsParticipants (n = 74) from the population-based Rotterdam Study, all with carotid atherosclerosis assessed on ultrasound, underwent carotid MRI. Multiple MRI sequences were used to evaluate the presence of IPH, LRNC and/or calcifications in plaques in the carotid arteries. Images were automatically segmented for lumen and outer wall to obtain a 3D reconstruction of the carotid bifurcation. These reconstructions were used to calculate minimum, mean and maximum shear stresses by applying computational fluid dynamics with subject-specific inflow conditions. Associations between shear stress measures and plaque composition were studied using generalized estimating equations analysis, adjusting for age, sex and carotid wall thickness. ResultsThe study group consisted of 93 atherosclerotic carotid arteries of 74 participants. In plaques with higher maximum shear stresses, IPH was more often present (OR per unit increase in maximum shear stress (log transformed) = 12.14; p = 0.001). Higher maximum shear stress was also significantly associated with the presence of calcifications (OR = 4.28; p = 0.015). ConclusionsHigher maximum shear stress is associated with intraplaque haemorrhage and calcifications.
Highlights
Atherosclerosis in the carotid arteries represents an important cause of ischemic stroke [1]
A higher SSmax was associated with presence of intraplaque haemorrhage (IPH) (odds ratio (OR) 12.14 (95% confidence intervals (CI) 3.21e45.94, p 1⁄4 0.001)
In 74 persons with asymptomatic carotid atherosclerosis, who were sampled from a population-based setting, we evaluated the association between shear stress and carotid plaque composition
Summary
Atherosclerosis in the carotid arteries represents an important cause of ischemic stroke [1]. It is known that plaques develop at distinct locations in the arterial system, for instance, the inner curve, close to side branches and in the bulbs of the carotid artery [10e12] At these locations, the shear stress, the drag force of the blood at the vessel wall, is mainly low and/or oscillatory. To date little is known on the association between shear stress and plaque composition in human carotid arteries. Carotid artery plaques with vulnerable plaque components are related to a higher risk of cerebrovascular accidents. We evaluated the association between shear stress and plaque components (intraplaque haemorrhage (IPH), lipid rich necrotic core (LRNC) and/or calcifications) in relatively small carotid artery plaques in asymptomatic persons. Conclusions: Higher maximum shear stress is associated with intraplaque haemorrhage and calcifications
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