Arterial Wall Shear Stress Research Articles

Dynamics of the blood flow in the curved artery with the rolling massage

Arterial wall shear stress and flow velocity are important factors in the development of some arterial diseases. Here, we aim to investigate the dynamic effect of the rolling massage on the property of the blood flow in the curved artery. The distributions of flow velocity and shear stress for the blood flow are computed by the lattice Boltzmann method, and the dynamic factors under different rolling techniques are studied numerically. The study is helpful to understand the mechanism of the massage and develop the massage techniques.

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

Low wall shear stress (WSS) is an early marker in the development of vascular lesions. The present study aims to assess the relationship between diastolic and systolic WSS in the internal carotid artery and periventricular (PWML), deep white matter lesions, and cerebral infarcts (CI). Early, mid, and late diastolic and peak systolic WSS were derived from shear rate obtained by gradient echo phase contrast magnetic resonance sequences multiplied by individually modeled viscosity. PWML, deep white matter lesions, and CI were derived from proton density (PD), T2, and fluid attenuated inversion recovery (FLAIR) MRI in 329 participants (70-82 years; PROSPER baseline). Analyses were adjusted, if appropriate, for age, gender, intracranial volume, and multiple cardiovascular risk factors. Mid-diastolic WSS was significantly correlated with the presence of PWML (B=-10.15; P=0.006) and CI (B=-2.06; P=0.044), but not with deep white matter lesions (B=-1.30; P=0.050; adjusted for age, gender, WML, and intracranial volume). After adjustment for cardiovascular risk factors, these correlations weakened but remained significant. Systolic WSS was not correlated with any of the cerebrovascular parameters. This study is the first to our knowledge to present a cross-sectional correlation between carotid artery WSS and cerebrovascular pathology such as PWML and CI in a large population. Furthermore, it shows that diastolic hemodynamics may be more important than systolic or mean hemodynamics. Future studies exploring vascular hemodynamic damage should focus on diastolic WSS.

Mining Data From Hemodynamic Simulations for Generating Prediction and Explanation Models

One of the most common causes of human death is stroke, which can be caused by carotid bifurcation stenosis. In our work, we aim at proposing a prototype of a medical expert system that could significantly aid medical experts to detect hemodynamic abnormalities (increased artery wall shear stress). Based on the acquired simulated data, we apply several methodologies for1) predicting magnitudes and locations of maximum wall shear stress in the artery, 2) estimating reliability of computed predictions, and 3) providing user-friendly explanation of the model's decision. The obtained results indicate that the evaluated methodologies can provide a useful tool for the given problem domain.

Coronary Artery Wall Shear Stress Is Associated With Progression and Transformation of Atherosclerotic Plaque and Arterial Remodeling in Patients With Coronary Artery Disease

Experimental studies suggest that low wall shear stress (WSS) promotes plaque development and high WSS is associated with plaque destabilization. We hypothesized that low-WSS segments in patients with coronary artery disease develop plaque progression and high-WSS segments develop necrotic core progression with fibrous tissue regression. Twenty patients with coronary artery disease underwent baseline and 6-month radiofrequency intravascular ultrasound (virtual histology intravascular ultrasound) and computational fluid dynamics modeling for WSS calculation. For each virtual histology intravascular ultrasound segment (n=2249), changes in plaque area, virtual histology intravascular ultrasound-derived plaque composition, and remodeling were compared in low-, intermediate-, and high-WSS categories. Compared with intermediate-WSS segments, low-WSS segments developed progression of plaque area (P=0.027) and necrotic core (P<0.001), whereas high-WSS segments had progression of necrotic core (P<0.001) and dense calcium (P<0.001) and regression of fibrous (P<0.001) and fibrofatty (P<0.001) tissue. Compared with intermediate-WSS segments, low-WSS segments demonstrated greater reduction in vessel (P<0.001) and lumen area (P<0.001), and high-WSS segments demonstrated an increase in vessel (P<0.001) and lumen (P<0.001) area. These changes resulted in a trend toward more constrictive remodeling in low- compared with high-WSS segments (73% versus 30%; P=0.06) and more excessive expansive remodeling in high- compared with low-WSS segments (42% versus 15%; P=0.16). Compared with intermediate-WSS coronary segments, low-WSS segments develop greater plaque and necrotic core progression and constrictive remodeling, and high-WSS segments develop greater necrotic core and calcium progression, regression of fibrous and fibrofatty tissue, and excessive expansive remodeling, suggestive of transformation to a more vulnerable phenotype. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00576576.

Arterial Wall Shear Stress Measurement In Vivo Using Echo Particle Image Velocimetry (Echo PIV)

Wall shear stress (WSS) is an important determinant of vascular endothelial function and vascular health. However, the in vivo measurement of WSS is, at present, difficult or impractical to perform. Echo Particle Image Velocimetry (Echo PIV) is a novel ultrasound-based technique capable of measuring detailed blood flow and hemodynamic information with high temporal and excellent spatial resolution. Echo PIV has been validated in vitro but its ability to measure WSS in vivo has not been established. PURPOSE: The purpose of this study was to compare WSS obtained by Echo PIV and by phase-contrast MRI in the common carotid artery of human subjects. METHODS: Right common carotid artery blood flow and hemodynamics were determined in 30 healthy volunteers (50.2±12.9 yrs, 17 men) using Echo PIV and MRI on separate occasions. Echo PIV is the method that combines conventional B-mode ultrasound (Sonix RP, Ultrasonix Medical Corporation, Canada), and contrast agent (SonoVue, Bracco Diagnostics, Italy) to generate 2-D velocity vector maps. Data obtained from 7-10 cardiac cycles were ensemble averaged using concurrent ECG, and were processed offline using a custom-designed program. RESULTS: Peak WSS (mean±SD, dyne/cm2) for Echo PIV and for MRI were 13.7±3.4 and 15.3±5.0, respectively. Mean WSS (averaged over the cardiac cycle) was 7.2±1.7 and 8.1±2.8 for Echo PIV and for MRI, respectively. The correlation coefficients between Echo PIV and MRI in peak WSS and mean WSS were 0.71 and 0.76, respectively (p<0.05). CONCLUSION: The association between WSS measured using Echo PIV and MRI was reasonable. Inherent differences between Echo PIV and MRI measurements may account for at least some of the discrepancies between the two methods, e.g. low temporal and spatial resolution of MRI. We conclude that Echo PIV may be a feasible method for the in vivo assessment of WSS in human arteries. Further studies are planned to determine the utility of Echo PIV for measuring WSS in other vascular beds, such as the brachial and femoral arteries. Supported by grants from NSF (CTS-0421461) and NIH (HL 67393 & 072738).

It Is All About Flow Or, Why There Will Never Be One Optimal Blood Pressure Goal For Every Patient With Hypertension

It Is All About Flow Or, Why There Will Never Be One Optimal Blood Pressure Goal For Every Patient With Hypertension

Influence of non-Newtonian properties of blood on the wall shear stress in human atherosclerotic right coronary arteries.

The objective of this work is to investigate the effect of non-Newtonian properties of blood on the wall shear stress (WSS) in atherosclerotic coronary arteries using both Newtonian and non-Newtonian models. Numerical simulations were performed to examine how the spatial and temporal WSS distributions are influenced by the stenosis size, blood viscosity, and flow rate. The computational results demonstrated that blood viscosity properties had considerable effect on the magnitude of the WSS, especially where disturbed flow was observed. The WSS distribution is highly non-uniform both temporally and spatially, especially in the stenotic region. The maximum WSS occurred at the proximal side of the stenosis, near the outer wall in the curved artery with no stenosis. The lumen area near the inner wall distal to the stenosis region experienced a lower WSS during the entire cardiac cycle. Among the factors of stenosis size, blood viscosity, and flow rate, the size of the stenosis has the most significant effect on the spatial and temporal WSS distributions qualitatively and quantitatively.

The effect of arterial wall shear stress on the incremental elasticity of a conduit artery

The purpose of this investigation was to determine the effects of flow mediated dilatation on arterial incremental elasticity (E(inc) ). In four female anaesthetized pigs, the iliac artery and vein were connected by a shunt with a variable resistance which allowed blood flow and therefore shear stress to be regulated. E(inc) was calculated from simultaneous records of diameter and pressure throughout a minimum of four cardiac cycles. Passive increases in diameter (∼1-2%) throughout a cardiac cycle, brought about by pressure, resulted in a two- to threefold increase in E(inc) . In contrast, increases in shear stress caused active smooth muscle relaxation and a significant increase in diameter from 3.663 ± 0.215 mm to 4.488 ± 0.163 mm (mean ± SEM, P < 0.05) equivalent to a fractional increase in diameter (fD) of 1.5 with no significant change in mean arterial pressure, 108 ± 2 mmHg to 106 ± 1 mmHg (mean ± SEM). The average value of E(inc) per cardiac cycle at baseline was 2.17 ± 0.10 × 10(3) kPa and remained relatively constant until fD exceeded 1.3 thereafter increasing to a maximum of 9.23 ± 1.0 × 10(3) kPa. These results show that in a conduit artery during the dilatory response to shear stress, the interaction between smooth muscle and collagen operates so as to maintain E(inc) relatively constant over much of the working range of dilatation. This is consistent with a model of the arterial wall in which collagen is recruited both by passive stretch, in response to an increase in pressure and therefore wall stress, and also by active contraction of smooth muscle.

Carotid Artery Hemodynamics: Observing Patient-specific Changes with Amlodipine and Lisinopril by Using MR Imaging Computation Fluid Dynamics

To assess whether using magnetic resonance (MR) imaging combined with computational fluid dynamics (CFD) could reveal changes in common carotid artery (CCA) flow and wall shear stress (WSS) that might contribute to differences in CCA remodeling between amlodipine, a calcium channel blocker, and lisinopril, an angiotensin-converting enzyme inhibitor, despite similar reductions in blood pressure (BP). Institutional review board approval was obtained, and participants gave informed consent. Nine subjects with hypertension were recruited into a double-blind placebo-controlled randomized three-way crossover study to compare the hemodynamic effects of 7 days of treatment with placebo, amlodipine, or lisinopril. After each treatment period, patients underwent CCA ultrasonography, BP measurement, and MR imaging with CFD. Analyses were performed by using repeated-measures analysis of variance, followed by the Tukey test or the Wilcoxon matched-pairs test. Amlodipine and lisinopril lowered BP similarly, but CCA flow rate was significantly higher (P < .01) and distal vascular resistance was lower (P = .016) after amlodipine treatment than after lisinopril treatment. WSS on the inner wall of the CCA was significantly lower after lisinopril treatment than after amlodipine treatment (P = .03). The change in WSS in the CCA correlated with the change in vascular resistance (r = -0.85, P < .001). Amlodipine causes increased blood flow and increased time-averaged WSS in the CCA compared with lisinopril, despite similar reductions in BP. Differences in the subacute hemodynamic effects of amlodipine and lisinopril could contribute to the differences in CCA remodeling seen in long-term studies. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100788/-/DC1.

Feasibility of in vivo measurement of carotid wall shear rate using spiral fourier velocity encoded MRI

Arterial wall shear stress is widely believed to influence the formation and growth of atherosclerotic plaque; however, there is currently no gold standard for its in vivo measurement. The use of phase contrast MRI has proved to be challenging due to partial-volume effects and inadequate signal-to-noise ratio at the high spatial resolutions that are required. This work evaluates the use of spiral Fourier velocity encoded MRI as a rapid method for assessing wall shear rate in the carotid arteries. Wall shear rate is calculated from velocity histograms in voxels spanning the blood/vessel wall interface, using a method developed by Frayne and Rutt (Magn Reson Med 1995;34:378-387). This study (i) demonstrates the accuracy of the velocity histograms measured by spiral Fourier velocity encoding in a pulsatile carotid flow phantom compared with high-resolution two-dimensional Fourier transform phase contrast, (ii) demonstrates the accuracy of Fourier velocity encoding-based shear rate measurements in a numerical phantom designed using a computational fluid dynamics simulation of carotid flow, and (iii) demonstrates in vivo measurement of regional wall shear rate and oscillatory shear index in the carotid arteries of healthy volunteers at 3 T.

Coronary endothelial dysfunction is associated with a reduction in coronary artery compliance and an increase in wall shear stress

ObjectiveEndothelial dysfunction is associated with arterial stiffness in large arteries. The purpose of this study was to investigate the association between coronary endothelial dysfunction, coronary artery compliance and wall shear...

MRI-determined carotid artery flow velocities and wall shear stress in a mouse model of vulnerable and stable atherosclerotic plaque

We report here on the pre-clinical MRI characterization of an apoE-/- mouse model of stable and vulnerable carotid artery atherosclerotic plaques, which were induced by a tapered restriction (cast) around the artery. Specific focus was on the quantification of the wall shear stress, which is considered a key player in the development of the plaque phenotype. In vivo MRI was performed at 9.4 T. The protocol consisted of time-of-flight angiography, high-resolution T1- and T2-weighted black-blood imaging and phase-contrast flow velocity imaging as function of time in the cardiac cycle. Wall shear stress was determined by fitting the flow profile to a quadratic polynomial. Time-of-flight angiography confirmed preservation of blood flow through the carotid arteries in all cases. T1- and T2-weighted MRI resulted in high-resolution images in which the position of the cast, luminal narrowing introduced by cast and plaque, as well as the arterial wall could be well identified. Laminar flow with low wall shear stress (11.2+/- 5.2 Pa) was measured upstream to the cast at the position of the vulnerable plaque. Downstream to the cast at the position of the stable plaque, the apparent velocities were low, which is consistent with vortices and an oscillatory nature of the flow. Flow velocities and wall shear stress were successfully measured in this mouse model of stable and unstable plaque. The presented tools can be used to provide valuable insights in the pathogenesis of atherosclerosis.

Carotid and Basilar Artery Wall Shear Stress in Alzheimer’s Disease and Mild Cognitive Impairment

Background/Aims: Vascular pathology is increasingly seen as a factor contributing to the development of Alzheimer’s disease (AD). With this in mind we hypothesized that this vascular pathology could be directly detected in the arteries contributing to the cerebral circulation of mild cognitive impairment (MCI) and AD patients by means of wall shear stress (WSS) measurements. Methods: In this study we investigated the mean wall shear stress (MWSS), diastolic wall shear stress (DWSS) and systolic wall shear stress (SWSS) in the carotid and basilar arteries of control subjects (mean age: 72; SD: 8.8), patients suffering from MCI (mean age: 76; SD: 6.7), and patients suffering from AD (mean age: 72; SD: 8.2) that were consecutively referred to our outpatient memory clinic using in-house developed software on gradient echo phase-contrast MRI sequences. Results: We found that all these parameters were significantly lower in the carotid arteries of patients suffering from AD or MCI when compared to control subjects. In the basilar artery only DWSS was lower in MCI or AD patients compared to control subjects. In none of the arteries a difference was found for any WSS parameter between MCI and AD patients. WSS parameters were significantly associated (corrected for age and sex) with the degree of cognitive impairment. Conclusion: Increased vascular pathology, as expressed by lower WSS measures, was found in patients suffering from MCI and AD compared to normal controls. This might point to the involvement of vascular pathology in the development of AD.

Role of shear stress on nitrite and NOS protein content in different size conduit arteries of swine

Inherent fundamental difference exists among arteries of different sizes. The purpose of this study was to evaluate the relation between regional difference of wall shear stress (WSS) in various sizes arteries and contents of nitrite and NO synthase (NOS) isoforms. Five different conduit arteries in a wide range of diameter (1-8 mm) were examined in the hind limbs of 13 pigs. Blood flow rate and outer diameter were measured in vivo to determine WSS. Arterial tissues were harvested for the measurement of nitrite and NOS protein contents. The concentration of nitrite, a product of NO synthesis, was determined by high-performance liquid chromatography method. Western blot analysis was used to assess the protein contents of endothelial NOS (eNOS), inducible NOS (iNOS) and neuronal NOS (nNOS). Our data show that WSS increases with a decrease in artery diameter. Nitrite level increases with increasing WSS and hence decreases with artery diameter. The eNOS protein contents decrease with an increase in diameter. No significant difference for iNOS and nNOS protein contents was found with different artery diameter. A significant positive correlation between tissue nitrite and eNOS protein contents was also observed. Finally, the WSS-normalized eNOS is not significantly different in various size vessels. Regional difference in blood flow has no effect on iNOS and nNOS protein contents in these conduit arteries. Regional difference in eNOS expression and nitrite contents may be related to the WSS-induced NO by the endothelium under normal physiological conditions.

Relationship of lipoprotein-associated phospholipase A2 and oxidized low density lipoprotein in carotid atherosclerosis

Plasma levels of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and oxidized low density lipoprotein (oxLDL) have been identified as risk factors for cardiovascular disease. Lp-PLA(2) is the sole enzyme responsible for the hydrolysis of oxidized phospholipids on LDL particles in atherosclerotic plaques. We have studied the relationship between Lp-PLA(2) and oxLDL in carotid endarterectomy (CEA) tissues and in matched plasmas. In extracts from CEA anatomical segments, the levels of oxLDL were significantly associated with the levels of Lp-PLA(2) protein (r = 0.497) and activity (r = 0.615). OxLDL and Lp-PLA(2) mass/activity were most abundant in the carotid bifurcation and internal segments where plaque was most abundant. In extracts from CEA atheroma, the levels of oxLDL and Lp-PLA(2) were significantly correlated (r = 0.634). In matched plasma and atheroma extracts, the levels of Lp-PLA(2) were negatively correlated (r = - 0.578). The ratio of Lp-PLA(2) to oxLDL was higher in atheromatous tissue (277:1) than in normal tissue (135:1) and plasma (13:1). Immunohistochemical experiments indicated that in plaques, oxLDL and Lp-PLA(2) existed in overlapping but distinctly different distribution. Fluorescence microscopy showed both oxLDL and Lp-PLA(2) epitopes on the same LDL particle in plasma but not in plaque. These results suggest that the relationship between Lp-PLA(2) and oxLDL in the atherosclerotic plaque is different from that in the plasma compartment.

Effect of compliance and hematocrit on wall shear stress in a model of the entire coronary arterial tree.

A hemodynamic analysis is implemented in the entire coronary arterial tree of diastolically arrested, vasodilated pig heart that takes into account vessel compliance and blood viscosity in each vessel of a large-scale simulation involving millions of vessels. The feed hematocrit (Hct) is varied at the inlet of the coronary arterial tree, and the Fahraeus-Lindqvist effect and phase separation are considered throughout the vasculature. The major findings are as follows: 1) vessel compliance is the major determinant of nonlinearity of the pressure-flow relation, and 2) changes in Hct influence wall shear stress (WSS) in epicardial coronary arteries more significantly than in transmural and perfusion arterioles because of the Fahraeus-Lindqvist effect. The present study predicts the flow rate as a second-order polynomial function of inlet pressure due to vessel compliance. WSS in epicardial coronary arteries increases >15% with an increase of feed Hct from 45% to 60% and decreases >15% with a decrease of feed Hct from 45% to 30%, whereas WSS in small arterioles is not affected as feed Hct changes in this range. These findings have important implications for acute Hct changes under vasodilated conditions.

Unsteady viscous flow with variable viscosity in a vascular tube with an overlapping constriction

Numerical solution of the unsteady viscous flow in the neighborhood of an overlapping constriction is obtained under laminar flow conditions with the motivation for modeling blood flow through a local occlusion of artery formed due to arterial disease. The flowing blood is considered to be incompressible, Newtonian with variable blood viscosity. The functional dependence of blood viscosity on haematocrit (percentage volume of red cells) has been duly accounted for in order to improve resemblance to the real situation. The finite-difference technique with staggered grid distribution is employed to solve the governing equations. The recirculation regions are formed in the downstream of the overlapping constriction. It is noticed that the arterial wall shear stress, pressure distribution and flow rate in particular, in the constricted site, are significantly altered. The peak value of wall shear stress decrease with increasing haematocrit parameter. The flow separation region increases with increasing haematocrit parameter. The results are presented graphically and analyzed in detail to study the effects of variable blood viscosity on the flow field. The motion of the arterial wall and its effects on local flow dynamics are considered. The contribution of deformability of the arterial wall is to reduce the wall shear stress in comparison to the consideration of rigid wall. Arterial wall motion causes to diminish the wall shear stress significantly.

Coronary Artery WSS Profiling Using a Geometry Reconstruction Based on Biplane Angiography

Computational fluid dynamics (CFD) methods based on three-dimensional (3D) vessel reconstructions have recently been shown to provide prognostically relevant hemodynamic data. However, the geometry reconstruction and the assessment of clinically relevant hemodynamic parameters may depend on the used imaging modality. In this study, the silicon model of the left coronary artery (LCA) was acquired with a biplane angiography. The geometry reconstruction was done using commercial CAAS 5.2 QCA 3D software and compared with an original geometry. The original model is an optically digitized post-mortem vessel cast. The biplane angiography reconstruction achieved a Hausdorff surface distance of 0.236 mm to the original geometry that is comparable with results obtained in our earlier study for computed tomography (CT) and magnetic resonance imaging (MRI) reconstructions. Steady flow simulations were performed with a commercial CFD program FLUENT. A comparison of the calculated wall shear stress (WSS) shows good correlation for histograms (r=0.97) and good agreement among the four modalities with a mean WSS of 0.65 Pa in the original model, of 0.68 Pa in the CT-based model, of 0.67 Pa in the MRI based model, and of 0.69 Pa in the biplane angiography-based model. We can conclude that the biplane angiography-based reconstructions can be used for the WSS profiling of the coronary arteries.

Discovery of the Role of Wall Shear in Atherosclerosis

The suggestion was made in the 1870s that mechanical irritation of the arterial wall is a cause of atherosclerosis, because the changes were chiefly found at points "exposed to the full stress and impact of the blood." The mechanical damage theory persisted until well into the 20th century when, with interest increasing in multidisciplinary research, two fluid mechanical proposals were advanced for the patchy distribution of the lesions. One advocated high- and the other low-wall shear. Arterial wall shear stress levels appeared, however, insufficiently high to damage the endothelium. In contrast, examination of cadaver human arteries, combined with flow studies in models and casts of arteries, implied that the lesions occurred preferentially in regions expected to experience low-wall shear; a mechanism, involving arterial wall lipid metabolism and shear-dependent blood-wall mass transport, was suggested to account for that distribution. These proposals helped stimulate extensive investigation of arterial fluid mechanics/mass transport and vascular biology/pathology, revealing mechanisms that may explain the now widely confirmed preferred occurrence of atherosclerosis in low wall shear regions in adult human beings.

Abstract 3759: Enhanced External Counterpulsation Arrests the Progression of Atherosclerosis by Regulating Cellular Apoptosis and Proliferation Signaling Pathway

Shear stress may be the most crucial local factor affecting atherogenesis. Enhanced External Counterpulsation (EECP) has been documented to increase arterial wall shear stress in vivo. We hypothesize that chronic exposure to increased pulsatile shear stress by EECP arrests the progression of atherosclerosis due to hypercholesterolemia. Forty-eight pigs were randomized to usual diet (n = 7), high-cholesterol diet (n = 18), and high-cholesterol diet plus EECP (34±2 hours, n = 23). At week 15, the left anterior descending coronary arteries (LAD) were collected for HE staining, transmission electron microscopy examination, immunohistochemical analysis of AKT, caspase- 3 and TUNEL assay. Expression and localization of NK- κB was assessed by immunofluorescence and confocal laser scanning microscope. The aortas were isolated for Sudan staining and Western-blot analysis. Blood lipids, viscosity, Doppler ultrasound flow examination was performed. Statistical analysis was by Kruskal-Wallis and Mann-Whitney tests. During EECP, the peak diastolic arterial wall shear stress in the right brachial artery increased significantly compared with baseline (53.18±3.81 dynes/cm 2 versus 23.92±2.02 dynes/cm 2 , p&lt;0.001), as well as the mean arterial wall shear stress (27.46±2.22 dynes/cm 2 versus 20.43±1.87 dynes/cm 2 , p &lt; 0.001). High-cholesterol diet induced remarkable atherosclerotic lesions with excessive cellular proliferation and apoptosis. In comparison, hypercholesterolemic animals receiving EECP showed ameliorated atherosclerotic lesions in LADs ( lesion/medial area ratio: 19.71±3.79 % versus 7.32±1.59 %, p = 0.001) and aortas (percentage of plaque area: 9.95±1.81 % versus 5.16±1.08 %, p = 0.011), coupled with decreased TUNEL positive staining (64±2.08 % versus 49±2.27 %, p &lt; 0.001), reduced caspase- 3 protein expression, AKT and NF- κB activity. This study demonstrates that EECP administration leads to reduced atherosclerotic lesions, coupled with dual inhibitory effects on vascular cellular proliferation and apoptosis. Its mechanisms are related to chronic increased shear stress by EECP suppressing the over-activation of the AKT/NF-κB signaling pathway.