Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
J Biomech. 2014 Mar 3;47(4):773-83. doi: 10.1016/j.jbiomech.2014.01.019. Epub 2014 Jan 14.
Progression and rupture of atherosclerotic plaques in coronary and carotid arteries are the key processes underlying myocardial infarctions and strokes. Biomechanical stress analyses to compute mechanical stresses in a plaque can potentially be used to assess plaque vulnerability. The stress analyses strongly rely on accurate representation of the mechanical properties of the plaque components. In this review, the composition of intima tissue and how this changes during plaque development is discussed from a mechanical perspective. The plaque classification scheme of the American Heart Association is reviewed and plaques originating from different vascular territories are compared. Thereafter, an overview of the experimental studies on tensile and compressive plaque intima properties are presented and the results are linked to the pathology of atherosclerotic plaques. This overview revealed a considerable variation within studies, and an enormous dispersion between studies. Finally, the implications of the dispersion in experimental data on the clinical applications of biomechanical plaque modeling are presented. Suggestions are made on mechanical testing protocol for plaque tissue and on using a standardized plaque classification scheme. This review identifies the current status of knowledge on plaque mechanical properties and the future steps required for a better understanding of the plaque type specific material properties. With this understanding, biomechanical plaque modeling may eventually provide essential support for clinical plaque risk stratification.
动脉粥样硬化斑块在冠状动脉和颈动脉中的进展和破裂是心肌梗死和中风的关键过程。生物力学应力分析可用于计算斑块中的机械应力，从而评估斑块的脆弱性。这些应力分析强烈依赖于对斑块成分的机械性能的准确表示。在这篇综述中，从力学角度讨论了内膜组织的组成以及在斑块发展过程中这种组成的变化。回顾了美国心脏协会的斑块分类方案，并比较了来自不同血管区域的斑块。此后，介绍了关于拉伸和压缩斑块内膜特性的实验研究概述，并将结果与动脉粥样硬化斑块的病理学联系起来。该综述显示，研究之间存在相当大的差异，而且研究之间存在巨大的离散性。最后，提出了关于斑块组织力学测试方案和使用标准化斑块分类方案的建议。该综述确定了目前对斑块力学特性的认识状况，以及为更好地了解特定斑块类型的材料特性所需的未来步骤。通过这种理解，生物力学斑块建模最终可能为临床斑块风险分层提供重要支持。
