Biomechanics of plaque rupture: progress, problems, and new frontiers

Area of Science:

• Cardiovascular Biomechanics
• Biomedical Engineering
• Pathology

Background:

• Plaque rupture is a critical step in arterial disease progression, often triggering thrombotic events.
• Vulnerable plaques, even before rupture, are a focus of clinical concern.
• Understanding plaque mechanics is key to predicting cardiovascular events.

Purpose of the Study:

• To review current knowledge on arterial plaque vulnerability.
• To identify data gaps in the mechanical assessment of plaques and their relationship to vessel geometry.
• To propose a framework for assessing plaque vulnerability.

Main Methods:

• Integration of data from structural and fluid mechanics.
• Analysis of plaque morphology and epidemiological pathology.
• Review of micromechanical measurements of arterial tissues and matrix metalloproteinase roles.
• Consideration of advanced imaging techniques like biplane angiography and intravascular ultrasound.

Main Results:

• Significant paucity of data exists on the mechanical behavior of small arterial tissue samples.
• Limited data relates plaque location to local vessel curvature and flexure.
• Emerging imaging technologies offer new avenues for clinical and biomechanical investigation.

Conclusions:

• Further research is needed on the mechanical properties of arterial tissues and plaque-geometry interactions.
• Advanced imaging and tissue assessment can enhance understanding of plaque vulnerability.
• Development of a standardized plaque vulnerability assessment scale is proposed.