Key result
Patient-specific biomechanical analysis calculated a von Mises stress of 152 kPa (95% CI 131-172) at the smallest fibrous cap thickness, a level predictive of plaque failure.
Why the study?
Rupture of unstable atherosclerotic plaques causes myocardial infarction and stroke, yet assessing this non-invasively for individual patients has not been possible, leaving guidelines reliant on luminal narrowing.
Case Report
Patient-specific tissue characterization from CTA can identify distributions of stress and strain to potentially identify high-risk atherosclerotic lesions and personalize treatment.
Patient-specific stress nearing failure thresholds may refine vulnerability assessment; leaves open prospective validation before clinical use.
BACKGROUND: Rupture of unstable atherosclerotic plaques with a large lipid-rich necrotic core and a thin fibrous cap cause myocardial infarction and stroke. Yet it has not been possible to assess this for individual patients. Clinical guidelines still rely on use of luminal narrowing, a poor indicator but one that persists for lack of effective means to do better. We present a case study demonstrating the assessment of biomechanical indices pertaining to plaque rupture risk non-invasively for individual patients enabled by histologically validated tissue characterization. METHODS: Routinely acquired clinical images of plaques were analyzed to characterize vascular wall tissues using software validated by histology (ElucidVivo, Elucid Bioimaging Inc.). Based on the tissue distribution, wall stress and strain were then calculated at spatial locations with varied fibrous cap thicknesses at diastolic, mean and systolic blood pressures. RESULTS: The von Mises stress of 152 [131, 172] kPa and the equivalent strain of 0.10 [0.08, 0.12] were calculated where the fibrous cap thickness was smallest (560 μm) (95% CI in brackets). The stress at this location was at a level predictive of plaque failure. Stress and strain at locations with larger cap thicknesses were calculated to be lower, demonstrating a clinically relevant range of risk levels. CONCLUSION: Patient specific tissue characterization can identify distributions of stress and strain in a clinically relevant range. This capability may be used to identify high-risk lesions and personalize treatment decisions for individual patients with cardiovascular disease and improve prevention of myocardial infarction and stroke.
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Buckler et al. (2022) conducted a case report in Atherosclerotic plaques. Patient-specific biomechanical analysis from computed tomography angiography was evaluated on von Mises stress and equivalent strain. Patient-specific biomechanical analysis calculated a von Mises stress of 152 kPa (95% CI 131-172) at the smallest fibrous cap thickness, a level predictive of plaque failure.
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