Identification of the haemodynamic environment permissive for plaque erosion

Identification of the haemodynamic environment permissive for plaque erosion

McElroy, Michael (The University of Manchester)
Kim, Yongcheol (Yonsei University College of Medicine)
Niccoli, Giampaolo (University of Parma)
Vergallo, Rocco (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Universita Cattolica del Sacro Cuore)
Langford-Smith, Alexander (Manchester Metropolitan University)
Crea, Filippo (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Universita Cattolica del Sacro Cuore)
Gijsen, F.J.H. (TU Delft ChemE/Transport Phenomena; Erasmus MC)
Johnson, Thomas
Keshmiri, Amir (The University of Manchester)

2021

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.

http://resolver.tudelft.nl/uuid:9ec91266-1516-43b7-81ca-f844002a542d

https://doi.org/10.1038/s41598-021-86501-x

2045-2322

Scientific Reports, 11 (1)

Institutional Repository

journal article

© 2021 Michael McElroy, Yongcheol Kim, Giampaolo Niccoli, Rocco Vergallo, Alexander Langford-Smith, Filippo Crea, F.J.H. Gijsen, Thomas Johnson, Amir Keshmiri, More Authors