Abstract
Carotid plaque neovascularization is one of the major factors for the classification of vulnerable plaque, but the axial force effects of the pulsatile blood flow on the plaque with neovessel and intraplaque hemorrhage was unclear. Together with the severity of stenosis, the fibrous cap thickness, large lipid core, and the neovascularization followed by intraplaque hemorrhage (IPH) have been regarded as high-risk features of plaque rupture. In this work, the effects of these factors were evaluated on the progression and rupture of the carotid atherosclerotic plaques. Five geometries of carotid artery plaque were developed based on contrast-enhanced ultrasound (CEUS) images, which contain two types of neovessel and IPH, and geometry without neovessel and IPH. A one-way fluid-structure interaction model was applied to compute the maximum principal stress and strain in the plaque. For that hyper-elastic and non-linear material, Yeoh 3rd Order strain energy density function was used for components of the plaque. The simulation results indicated that the maximum principal stress of plaque in the carotid artery was higher when the degree of the luminal stenosis increased and the thickness of the fibrous cap decreased. The neovessels within the plaque could introduce a 2.5% increments of deformation in the plaque under the pulsatile blood flow pressure. The IPH also contributed to the increased risk of plaque rupture that a gain of stress was 8.983, 14.526, and 34.47 kPa for the plaque with 50, 65, and 75%, respectively, when comparing stress in the plaque with IPH distributed at the middle to the shoulder of the plaque. In conclusion, neovascularization in the plaque could reduce the stability of the plaque by increasing the stress within the plaque. Also, the risk of plaque rupture increased when large luminal stenosis, thin fibrous cap, and IPH were observed.
Highlights
Carotid atherosclerotic plaque is one of the most common causes of stroke (Rossi et al, 2002; Murata et al, 2020), based on the fibrous cap, lipid core, and endothelial denudation with superficial platelet aggregation being closely associated with the incident (Sadat et al, 2009)
Thin fibrous cap and large lipid core are the major factors of the vulnerable plaque and high risk of the plaque rupture (Falk et al, 1995; Naghavi et al, 2003; Finn et al, 2010), as rupture is commonly found in the plaque with the thickness of the fibrous cap
The deformation of the neovessel was in line with the observation in the Contrast-enhanced ultrasound (CEUS) images that the shape of neovessel changes along with the pulsatile blood flow, which suggested that the stress on the plaque could further induce the stress on the neovessel
Summary
Carotid atherosclerotic plaque is one of the most common causes of stroke (Rossi et al, 2002; Murata et al, 2020), based on the fibrous cap, lipid core, and endothelial denudation with superficial platelet aggregation being closely associated with the incident (Sadat et al, 2009). Neovascularization in the carotid atherosclerotic plaque is the maker of a high risk of the vulnerable plaque (Moreno et al, 2004; Dunmore et al, 2006; Huang et al, 2008; Van der Veken et al, 2016; Demeure et al, 2017). Denmark and Marcin (2011) reported that the increased density of the neovascularization was associated with the increasing vulnerability degree of the carotid atherosclerosis plaque Contrast-enhanced ultrasound (CEUS) imaging has been applied to assess the neovascularization in carotid atherosclerosis plaques, for additional evaluation of the vulnerable plaque during the screening procedure for stroke in clinical practice (Feinstein, 2006; Vicenzini et al, 2007; Schinkel et al, 2020; Zamani et al, 2020). Xiong et al (2009) reported that symptomatic patients had more intense contrast agent within the plaque than asymptomatic patients. Denmark and Marcin (2011) reported that the increased density of the neovascularization was associated with the increasing vulnerability degree of the carotid atherosclerosis plaque
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