Abstract
Mechanical analysis has been shown to be complementary to luminal stenosis in assessing atherosclerotic plaque vulnerability. However, patient-specific material properties are not available and the effect of material properties variability has not been fully quantified. Media and fibrous cap (FC) strips from carotid endarterectomy samples were classified into hard, intermediate and soft according to their incremental Young's modulus. Lipid and intraplaque haemorrhage/thrombus strips were classified as hard and soft. Idealised geometry-based 3D fluid-structure interaction analyses were performed to assess the impact of material property variability in predicting maximum principal stress (Stress-P1) and stretch (Stretch-P1). When FC was thick (1000 or 600 µm), Stress-P1 at the shoulder was insensitive to changes in material stiffness, whereas Stress-P1 at mid FC changed significantly. When FC was thin (200 or 65 µm), high stress concentrations shifted from the shoulder region to mid FC, and Stress-P1 became increasingly sensitive to changes in material properties, in particular at mid FC. Regardless of FC thickness, Stretch-P1 at these locations was sensitive to changes in material properties. Variability in tissue material properties influences both the location and overall stress/stretch value. This variability needs to be accounted for when interpreting the results of mechanical modelling. © 2015 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.
Highlights
Stroke is the leading cause of disability worldwide and remains a significant source of mortality [1]
This study aims to assess the influence of variability in material properties of media, fibrous cap (FC), lipid and intraplaque haemorrhage (IPH)/T obtained from direct material tests on stress and stretch conditions within the plaque structure
If the FC was changed to be soft (Figure 4B), both stress and stretch in the shoulder region decreased by 15.8% and 0.9%, respectively, and the values at the mid FC decreased by 13.5% and increased by 5.6%
Summary
Stroke is the leading cause of disability worldwide and remains a significant source of mortality [1]. Carotid atherosclerotic disease is responsible for around 30% of all ischemic strokes [2]. There is increasing evidence to suggest that the physical characteristics of atherosclerotic plaques, and the mechanical loading within the structure, may allow greater potential to discriminate clinical progression than luminal stenosis alone. A vulnerable carotid atherosclerotic plaque is characterised by the presence of intraplaque haemorrhage (IPH) and a large lipid-rich necrotic core, with symptomatic plaques showing evidence.
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