Colmenarez Jose A, Dong Pengfei, Lee Juhwan, Wilson David L, Gu Linxia
Department of Biomedical Engineering and Science, Florida Institute of Technology, 150 West University Boulevard, Melbourne, FL 32901.
Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106.
J Biomech Eng. 2025 Feb 1;147(2). doi: 10.1115/1.4067398.
Lipid-rich atheromas are linked to plaque rupture in stented atherosclerotic arteries. While fibrous cap thickness is acknowledged as a critical indicator of vulnerability, it is likely that other morphological features also exert influence. However, detailed quantifications of their contributions and intertwined effects in stenting are lacking. Therefore, our goal is to assess the impact of plaque characteristics on the fibrous cap stress and elucidate their underlying mechanisms. We analyzed the stent deployment in a three-dimensional patient-specific coronary artery reconstructed from intravascular optical coherence tomography (IVOCT) data using the finite element method. Additionally, we performed sensitivity analysis on 78,000 distinct plaque geometries of two-dimensional arterial cross section for verification. Results from the three-dimensional patient-specific model indicate strong correlations between maximum fibrous cap stress and lipid arc (r=0.769), area stenosis (r=0.550), and lumen curvature (r=0.642). Plaques with lipid arcs >60 deg, area stenosis >75%, and lumen curvatures >5 mm-1 are at rupture risk. While we observed a rise in stress with thicker lipid cores, it was less representative than other features. Fibrous cap thickness showed a poor correlation, with the sensitivity analysis revealing its significance only when high stretches are induced by other features, likely due to its J-shaped stress-stretch response. Contrary to physiological pressure, the stent expansion generates unique vulnerable features as the stent load-transferring characteristics modify the plaque's response. This study is expected to prompt further clinical investigations of other morphological features for predicting plaque rupture in stenting.
富含脂质的动脉粥样瘤与置入支架的动脉粥样硬化动脉中的斑块破裂有关。虽然纤维帽厚度被认为是易损性的关键指标，但其他形态特征可能也会产生影响。然而，目前缺乏对它们在支架置入过程中的作用及其相互交织效应的详细量化。因此，我们的目标是评估斑块特征对纤维帽应力的影响，并阐明其潜在机制。我们使用有限元方法分析了从血管内光学相干断层扫描（IVOCT）数据重建的三维个体化冠状动脉中的支架置入情况。此外，我们对二维动脉横截面的78000种不同斑块几何形状进行了敏感性分析以进行验证。三维个体化模型的结果表明，最大纤维帽应力与脂质弧（r = 0.769）、面积狭窄（r = 0.550）和管腔曲率（r = 0.642）之间存在强相关性。脂质弧>60°、面积狭窄>75%和管腔曲率>5 mm-1的斑块有破裂风险。虽然我们观察到脂质核心越厚应力会增加，但其代表性不如其他特征。纤维帽厚度的相关性较差，敏感性分析表明，只有当其他特征引起高拉伸时它才具有显著性，这可能是由于其J形应力-拉伸反应。与生理压力相反，支架扩张会产生独特的易损特征，因为支架的载荷传递特性会改变斑块的反应。本研究有望促使对其他形态特征进行进一步临床研究，以预测支架置入时的斑块破裂。
