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Identification of the haemodynamic environment permissive for plaque erosion

 Michael McElroy  ;  Yongcheol Kim  ;  Giampaolo Niccoli  ;  Rocco Vergallo  ;  Alexander Langford-Smith  ;  Filippo Crea  ;  Frank Gijsen  ;  Thomas Johnson  ;  Amir Keshmiri  ;  Stephen J White 
 SCIENTIFIC REPORTS, Vol.11(1) : 7253, 2021-03 
Journal Title
Issue Date
Acute Coronary Syndrome / diagnostic imaging ; Acute Coronary Syndrome / physiopathology* ; Adult ; Aged ; Female ; Hemodynamics* ; Humans ; Male ; Middle Aged ; Models, Cardiovascular* ; Plaque, Atherosclerotic / diagnostic imaging ; Plaque, Atherosclerotic / physiopathology* ; Stress, Mechanical* ; Tomography, Optical Coherence
Endothelial erosion of atherosclerotic plaques is the underlying cause of approximately 30% of acute coronary syndromes (ACS). As the vascular endothelium is profoundly affected by the haemodynamic environment to which it is exposed, we employed computational fluid dynamic (CFD) analysis of the luminal geometry from 17 patients with optical coherence tomography (OCT)-defined plaque erosion, to determine the flow environment permissive for plaque erosion. Our results demonstrate that 15 of the 17 cases analysed occurred on stenotic plaques with median 31% diameter stenosis (interquartile range 28-52%), where all but one of the adherent thrombi located proximal to, or within the region of maximum stenosis. Consequently, all flow metrics related to elevated flow were significantly increased (time averaged wall shear stress, maximum wall shear stress, time averaged wall shear stress gradient) with a reduction in relative residence time, compared to a non-diseased reference segment. We also identified two cases that did not exhibit an elevation of flow, but occurred in a region exposed to elevated oscillatory flow. Our study demonstrates that the majority of OCT-defined erosions occur where the endothelium is exposed to elevated flow, a haemodynamic environment known to evoke a distinctive phenotypic response in endothelial cells.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yongcheol(김용철) ORCID logo https://orcid.org/0000-0001-5568-4161
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