Abstract
The role of wall shear stress (WSS) in atherosclerotic plaque development is evident, but the relation between WSS and plaque composition in advanced atherosclerosis, potentially resulting in plaque destabilization, is a topic of discussion. Using our previously developed image registration pipeline, we investigated the relation between two WSS metrics, time-averaged WSS (TAWSS) and the oscillatory shear index (OSI), and the local histologically determined plaque composition in a set of advanced human carotid plaques. Our dataset of 11 carotid endarterectomy samples yielded 87 histological cross-sections, which yielded 511 radial bins for analysis. Both TAWSS and OSI values were subdivided into patient-specific low, mid, and high tertiles. This cross-sectional study shows that necrotic core (NC) size and macrophage area are significantly larger in areas exposed to high TAWSS or low OSI. Local TAWSS and OSI tertile values were generally inversely related, as described in the literature, but other combinations were also found. Investigating the relation between plaque vulnerability features and different combinations of TAWSS and OSI tertile values revealed a significantly larger cap thickness in areas exposed to both low TAWSS and low OSI. In conclusion, our study confirmed previous findings, correlating high TAWSS to larger macrophage areas and necrotic core sizes. In addition, our study demonstrated new relations, correlating low OSI to larger macrophage areas, and a combination of low TAWSS and low OSI to larger cap thickness.
Highlights
Atherosclerosis is a gradually progressing disease of the arteries characterized by vessel wall thickening due to the accumulation of lipids and inflammatory cells
Registration accuracy of the remaining dataset was quantified by calculating the dice similarity coefficient (DSC) and Hausdorff distance (HD) between the lumen segmentations of the en face and histology cross-sections and between the en face and the transformed in vivo cross-sections
For the histology-to-en face registration, we found a mean HD of 0.55 ± 0.07 (SEM) mm and a mean DSC of 0.85 ± 0.02 (SEM)
Summary
Atherosclerosis is a gradually progressing disease of the arteries characterized by vessel wall thickening due to the accumulation of lipids and inflammatory cells. This is referred to as plaque formation. Atherosclerosis is a multifactorial disease that can be aggravated by lifestyle factors, such as high caloric diet, physical inactivity, and smoking, and by genetic factors. The initiation of plaque formation, has been strongly linked to a hemodynamic parameter: wall shear stress (WSS). WSS is the frictional force exerted by flowing blood on the vessel wall.
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