Bacigalupi Elena, Pizzicannella Jacopo, Rigatelli Gianluca, Scorpiglione Luca, Foglietta Melissa, Rende Greta, Mantini Cesare, Fiore Franco M, Pelliccia Francesco, Zimarino Marco
Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Department of Engineering and Geology, University "G. d' Annunzio" Chieti-Pescara, Pescara, Italy.
Front Cardiovasc Med. 2024 Jul 25;11:1392702. doi: 10.3389/fcvm.2024.1392702. eCollection 2024.
Although the entire vascular bed is constantly exposed to the same risk factors, atherosclerosis manifests a distinct intra-individual pattern in localization and progression within the arterial vascular bed. Despite shared risk factors, the development of atherosclerotic plaques is influenced by physical principles, anatomic variations, metabolic functions, and genetic pathways. Biomechanical factors, particularly wall shear stress (WSS), play a crucial role in atherosclerosis and both low and high WSS are associated with plaque progression and heightened vulnerability. Low and oscillatory WSS contribute to plaque growth and arterial remodeling, while high WSS promotes vulnerable changes in obstructive coronary plaques. Axial plaque stress and plaque structural stress are proposed as biomechanical indicators of plaque vulnerability, representing hemodynamic stress on stenotic lesions and localized stress within growing plaques, respectively. Advancements in imaging and computational fluid dynamics techniques enable a comprehensive analysis of morphological and hemodynamic properties of atherosclerotic lesions and their role in plaque localization, evolution, and vulnerability. Understanding the impact of mechanical forces on blood vessels holds the potential for developing shear-regulated drugs, improving diagnostics, and informing clinical decision-making in coronary atherosclerosis management. Additionally, Computation Fluid Dynamic (CFD) finds clinical applications in comprehending stent-vessel dynamics, complexities of coronary bifurcations, and guiding assessments of coronary lesion severity. This review underscores the clinical significance of an integrated approach, concentrating on systemic, hemodynamic, and biomechanical factors in atherosclerosis and plaque vulnerability among patients with coronary artery disease.
尽管整个血管床始终暴露于相同的风险因素，但动脉粥样硬化在动脉血管床内的定位和进展呈现出明显的个体内模式。尽管存在共同的风险因素，但动脉粥样硬化斑块的形成受物理原理、解剖变异、代谢功能和遗传途径的影响。生物力学因素，尤其是壁面剪应力（WSS），在动脉粥样硬化中起关键作用，低WSS和高WSS均与斑块进展及易损性增加有关。低且振荡的WSS会导致斑块生长和动脉重塑，而高WSS会促使阻塞性冠状动脉斑块发生易损性变化。轴向斑块应力和斑块结构应力被认为是斑块易损性的生物力学指标，分别代表狭窄病变上的血流动力学应力和生长斑块内的局部应力。成像和计算流体动力学技术的进步使得能够全面分析动脉粥样硬化病变的形态学和血流动力学特性及其在斑块定位、演变和易损性中的作用。了解机械力对血管的影响有望开发剪切调节药物、改善诊断并为冠状动脉粥样硬化管理中的临床决策提供依据。此外，计算流体动力学（CFD）在理解支架-血管动力学、冠状动脉分叉的复杂性以及指导冠状动脉病变严重程度评估方面有临床应用。本综述强调了综合方法的临床意义，重点关注冠状动脉疾病患者动脉粥样硬化和斑块易损性中的全身、血流动力学和生物力学因素。
