Coronary artery plaque formation at coronary CT angiography: morphological analysis and relationship to hemodynamics

Area of Science:

• Cardiovascular Imaging
• Atherosclerosis Pathophysiology
• Biomedical Engineering

Background:

• Atherosclerotic plaque formation is influenced by hemodynamic factors.
• Non-invasive imaging is crucial for studying these effects in vivo.
• Coronary CT angiography (cCTA) offers detailed anatomical and compositional information.

Purpose of the Study:

• To demonstrate the utility of cCTA in non-invasively assessing hemodynamic influences on plaque development.
• To characterize plaque distribution and composition in relation to vascular geometry and flow patterns.
• To correlate specific hemodynamic conditions with atherosclerotic plaque characteristics.

Main Methods:

• Analysis of cCTA data from 73 patients with 382 detected coronary plaques.
• Classification of plaques by location (bifurcation, non-branching), configuration (eccentric, concentric), orientation (myocardial, lateral, epicardial), and composition (calcified, mixed, non-calcified).
• Characterization of bifurcation lesions using the Medina classification.

Main Results:

• Plaques were predominantly found in the LAD (46.3%) and RCA (25.9%), with 51.3% located at bifurcations.
• The most common Medina pattern was 1.1.0 (40%). Most plaques were eccentric (80%) and located on the myocardial side (55%).
• Non-calcified and mixed plaques showed a significant preference for the myocardial wall (45.1%) compared to lateral or epicardial sides.

Conclusions:

• cCTA is a valuable tool for non-invasively investigating the impact of hemodynamics on atherosclerotic plaque.
• Turbulent flow at bifurcations and low shear stress on the myocardial vessel wall are associated with specific plaque distributions and compositions.
• Findings support the role of hemodynamics in guiding plaque deposition and progression.