The Need to Shift from Morphological to Structural Assessment for Carotid Plaque Vulnerability

Area of Science:

• Biomedical Engineering
• Cardiovascular Research
• Medical Imaging Analysis

Background:

• Degree of luminal stenosis is a common metric for atherosclerosis risk.
• However, similar stenosis degrees can mask diverse plaque morphologies and biomechanical properties.

Observation:

• Three patients with similar carotid stenosis degrees were analyzed.
• Fluid-structure interaction (FSI) modeling was employed to compare plaque morphology and biomechanics.

Findings:

• Significant differences in plaque components were observed despite comparable stenosis.
• Patient 2 exhibited a wider range of time-averaged wall shear stress (TAWSS) and lower plaque stress than patients 1 and 3.
• TAWSS and plaque stresses varied significantly among the patients.

Implications:

• Plaque vulnerability is a complex interplay of structural and biomechanical factors, not solely morphology.
• A shift from morphological to structural assessment is crucial for accurately evaluating plaque rupture risk.