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Updated: Aug 16, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Who is at risk for atherosclerotic disease? Lessons from intravascular ultrasound
1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Atherosclerosis develops early, with significant plaque buildup before vessel narrowing. Early intervention targeting risk factors is crucial for preventing heart disease.
Area of Science:
- Cardiovascular Medicine
- Pathology
- Medical Imaging
Background:
- Arterial wall remodeling allows substantial atherosclerotic plaque accumulation before lumen narrowing.
- Necropsy and intravascular ultrasound (IVUS) studies support this hypothesis.
- Atherosclerosis risk factors are active from a young age.
Purpose of the Study:
- To investigate the early development and progression of coronary atherosclerosis.
- To assess the relationship between arterial remodeling, plaque burden, and lumen stenosis.
- To emphasize the need for early intervention in coronary artery disease (CAD).
Main Methods:
- Intravascular ultrasound (IVUS) assessment of coronary arteries in transplant donors.
- Analysis of necropsy data for age-related atherosclerosis prevalence.
- Comparison of IVUS findings with coronary angiography results.
Main Results:
- Coronary atheromas detected in 17% of individuals <20 years, 37% aged 20-29, and 60% aged 30-39.
- Angiography was negative in 97% of the studied population, indicating early disease detection limitations.
- Atherosclerosis is diffuse, involving the entire arterial tree with non-stenotic, potentially rupture-prone plaques.
Conclusions:
- Significant coronary atherosclerosis burden can exist without detectable lumen narrowing.
- Early and aggressive intervention targeting modifiable risk factors is essential.
- Reducing CAD morbidity and mortality requires a systemic approach from a young age.
Abstract:
The hypothesis that arterial wall remodeling permits accumulation of a large atherosclerotic burden before there is any detectable narrowing of the vessel lumen has received support from necropsy and intravascular ultrasound (IVUS) studies. In a series of transplant donors assessed by IVUS, coronary atheromas were found in 17% of those younger than 20 years, 37% of those aged 20 to 29 years, and 60% of those aged 30 to 39 years, whereas angiography results were negative in 97% of this population. Necropsy data indicate a similar age-related prevalence and suggest that atherosclerosis risk factors are operative from a very early age. The IVUS findings show that disease is characteristically diffuse and involves the entire arterial tree, with progression including formation of multiple, potentially rupture-prone plaques that are not associated with vessel stenosis. These findings indicate the need for aggressive and early systemic intervention that targets modifiable risk factors to reduce coronary artery disease morbidity and mortality in the general population.
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