Intracoronary Shear Stress and CT Characteristics of Vulnerable Coronary Plaques

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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.


  • 1. Nyulas T, Chitu M, Mester A, et al. Computed tomography biomarkers of vulnerable coronary plaques. Journal of Interdisciplinary Medicine. 2016;1:263-266.

  • 2. Benedek T, Jako B, Benedek I. Plaque quantification by coronary CT and intravascular ultrasound identifies a low CT density score as a marker of plaque instability in acute coronary syndromes. Int Heart J. 2014;55:22-28.

  • 3. Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. 2014;11:390-402.

  • 4. Schaar JA, Muller JE, Falk E, et al. Terminology of high-risk and vulnerable coronary artery plaques. Eur Heart J. 2004;24:1077-1082.

  • 5. Ross R. Atherosclerosis is an inflammatory disease. Am Heart J. 1999;138:S419-S420.

  • 6. Dirksen MT, van der Wal AC, van der Berg FM, van der Loos CM, Becker AE. Distribution of inflammatory cells in atherosclerotic plaques relates to the direction of flow. Circulation. 1998;98:2000-2003.

  • 7. Traub O, Berk BC. Laminar shear stress: mechanisms by which endothelial cells transduce an atheroprotective force. Arterioscler Thromb Vasc Biol. 1998 May;18(5):677-85.

  • 8. Steiman DA. Image-based computational fluid dynamics modeling in realistic arterial geometries. Ann Biomed Eng. 2002;30:483-497.

  • 9. Sun Z, Xu L. Computational fluid dynamics in coronary artery disease. Comput Med Imaging Graph. 2014;38:651-663.

  • 10. Papaioannou TG, Stefanadis C. Vascular wall shear stress: basic principles and methods. Hellenic J Cardiol. 2005;46:9-15.

  • 11. Walpola PL, Gotlieb AI, Langille BL. Monocyte adhesion and changes in endothelial cell number, morphology, and F-actin distribution elicited by low shear stress in vivo. Am J Pathol. 1993;142:1392-1400.

  • 12. Davies PF. Flow-mediated endothelial Mechanotransduction. Physiol Rev. 1995;75:519-560.

  • 13. van der Giessen A, Schaap M, Gijsen FJ, et al. 3D fusion of intravascular ultrasound and coronary computed tomography for in-vivo wall shear stress analysis: a feasibility study. Int J Cardiovasc Imaging. 2010;26:781-796.

  • 14. Stone PH, Saito S, Takahashi S, et al. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics, the PREDICTION study. Circulation. 2012;126:172-181.

  • 15. Huang D, Muramatsu T, Li Y, et al. Assessment of endothelial shear stress in patients with mild or intermediate coronary stenoses using coronary computed tomography angiography: comparison with invasive coronary angiography. Int J Cardiovasc Imaging. 2017;33:1101-1110.

  • 16. Ohayon J, Finet G, Treyve F, Rioufol G, Dubreuil O. A three-dimensional finite element analysis of stress distribution in a coronary atherosclerotic plaque: in-vivo prediction of plaque rupture location. Biomechanics Applied to Computer Assisted Surgery. 2005:225-241.

  • 17. Giannopoulos AA, Chatzizisis YS, Maurovich-Horvat P, et al. Quantifying the effect of side branches in endothelial shear stress estimates. Atherosclerosis. 2016;251:213-218.

  • 18. Stone PH, Coskun AU, Prati F. Ongoing methodological approach to improve the in vivo assessment of local coronary blood flow and endothelial shear stress. J Am Coll Cardiol. 2015;66:136-138.

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