Wall shear stress as a stimulus for intra-plaque hemorrhage in carotid atherosclerotic plaque: An MRI-based CFD pilot study

Motivation Cells present in the arterial vessel wall respond to sustained altered values of hemodynamic forces modifying their structure and function at the cellular, molecular, and genetic levels to return these forces to their physiological values. However, under certain circumstances, this response may lead to pathologies, such as atherosclerosis. Recent studies have suggested that endothelial cells may modify the balance between cap-reinforcing extracellular matrix synthesis by smooth-muscle cells and extracellular matrix degradation by metalloproteinases secreted by infiltrating macrophages as a response to shear stress. These studies indicate that there might be a link between plaque distribution and composition and shear stress patterns. Magnetic resonance imaging (MRI) has emerged as a powerful tool to characterize human carotid atherosclerotic plaque composition and morphology . Furthermore, MRI is able to identify plaque features that have been shown to be key determinants of plaque vulnerability 4,5 ; however, the pathophysiological mechanism responsible for the presence of those features still needs to be determined