Vulnerable coronary plaques are associated with a significant risk for rupture, and the ability to detect their characteristic features is of extreme importance, as timely detection of rupture-prone plaques could lead to the appropriate initiation of adequate therapeutic measures and prevent the evolution to an acute coronary event. The most common features of vulnerability in coronary plaques are represented by the presence of low density atheroma, a thin fibrous cap, spotty calcifications, and positive remodeling. However, there is still a huge amount of information to be learned about the role of local forces, represented by the shear stress, on the plaque vulnerability. This clinical update aims to present the most recent advances in the field of knowledge regarding the relation between shear stress and plaque vulnerability, starting from the hypothesis that shear stress significantly correlates with the CT features of plaque vulnerability and can represent a new marker of vulnerability in coronary artery plaques.
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