Mechanical behavior of calcified plaques: a summary of compression and stress-relaxation experiments

This paper summarizes the results from mechanical testing of atherosclerotic plaques performed in the Cardiovascular Mechanics Laboratory and the Laboratory for Implantable Materials at UMBC. The motivation for our work is that balloon angioplasty, stenting, and roto-ablation are mechanical processes that are designed to permanently alter the shape of an occluded arterial lumen. The mechanisms of permanent plaque deformation are not known. Therefore, to study the mechanical behavior of plaques, we performed mechanical tests on atherosclerotic lesions with different compositions and investigated differences in the materials' mechanical responses. Atherosclerotic plaque specimens were subjected to two main types of loading: multiple cyclic compression and stress-relaxation. The multiple-cycle test protocol was two fifteen-cycle loading phases that were separated by a 10-15 minute unloaded "rest" period. The compressive stress-relaxation test protocol was a series of three consecutive loadings (called phases I, II, and III). Each phase consisted of a 25% compression that was achieved in less than 1 second, a 10 minute relaxation period, and a 10 minute unloaded "rest" period between loadings. In the multiple cycle compressive loading, plaques exhibited three distinct types of behavior, which corresponded to the plaque compositions. Calcified plaques showed behaviors distinct from other plaque types and healthy vessels. In contrast to the cyclic compression results, plaque types could not be distinguished solely on the basis of stress relaxation behavior. Calcified and fibrous plaques had similar behavior, and therefore histology was used for definite identification. Calcified plaques have unique mechanical properties, and therefore interventions like angioplasty, roto-ablation, and stenting may require protocols specific for calcified lesions. The optimum protocols for calcified plaques may be quite different from plaques with other compositions. It is essential to learn more about the mechanical behavior of all plaque types to increase the success rate of occlusive atherosclerosis treatments.