BACKGROUND: More than half of all cerebral ischemic events are the result of rupture of extracranial plaques. The clinical determination of carotid plaque vulnerability is currently based solely on luminal stenosis; however, it has been increasingly suggested that plaque morphology and biomechanical stress should also be considered. We used finite element analysis based on in vivo magnetic resonance imaging (MRI) to simulate the stress distributions within plaques of asymptomatic and symptomatic individuals. METHODS: Thirty non-consecutive subjects (15 symptomatic and 15 asymptomatic) underwent high-resolution multisequence in vivo MRI of the carotid bifurcation. Stress analysis was performed based on the geometry derived from in vivo MRI of the carotid artery at the point of maximal stenosis. The finite element analysis model considered plaque components to be hyperelastic. The peak stresses within the plaques of symptomatic and asymptomatic individuals were compared. RESULTS: High stress concentrations were found at the shoulder regions of symptomatic plaques, and the maximal stresses predicted in this group were significantly higher than those in the asymptomatic group (508.2 +/- 193.1 vs 269.6 +/- 107.9 kPa; P = .004). CONCLUSIONS: Maximal predicted plaque stresses in symptomatic patients were higher than those predicted in asymptomatic patients by finite element analysis, suggesting the possibility that plaques with higher stresses may be more prone to be symptomatic and rupture. If further validated by large-scale longitudinal studies, biomechanical stress analysis based on high resolution in vivo MRI could potentially act as a useful tool for risk assessment of carotid atheroma. It may help in the identification of patients with asymptomatic carotid atheroma at greatest risk of developing symptoms or mild-to-moderate symptomatic stenoses, which currently fall outside current clinical guidelines for intervention.
BACKGROUND: More than half of all cerebral ischemic events are the result of rupture of extracranial plaques. The clinical determination of carotid plaque vulnerability is currently based solely on luminal stenosis; however, it has been increasingly suggested that plaque morphology and biomechanical stress should also be considered. We used finite element analysis based on in vivo magnetic resonance imaging (MRI) to simulate the stress distributions within plaques of asymptomatic and symptomatic individuals. METHODS: Thirty non-consecutive subjects (15 symptomatic and 15 asymptomatic) underwent high-resolution multisequence in vivo MRI of the carotid bifurcation. Stress analysis was performed based on the geometry derived from in vivo MRI of the carotid artery at the point of maximal stenosis. The finite element analysis model considered plaque components to be hyperelastic. The peak stresses within the plaques of symptomatic and asymptomatic individuals were compared. RESULTS: High stress concentrations were found at the shoulder regions of symptomatic plaques, and the maximal stresses predicted in this group were significantly higher than those in the asymptomatic group (508.2 +/- 193.1 vs 269.6 +/- 107.9 kPa; P = .004). CONCLUSIONS: Maximal predicted plaque stresses in symptomatic patients were higher than those predicted in asymptomatic patients by finite element analysis, suggesting the possibility that plaques with higher stresses may be more prone to be symptomatic and rupture. If further validated by large-scale longitudinal studies, biomechanical stress analysis based on high resolution in vivo MRI could potentially act as a useful tool for risk assessment of carotid atheroma. It may help in the identification of patients with asymptomatic carotid atheroma at greatest risk of developing symptoms or mild-to-moderate symptomatic stenoses, which currently fall outside current clinical guidelines for intervention.
Authors: Chun Yang; Richard G Bach; Jie Zheng; Issam Ei Naqa; Pamela K Woodard; Zhongzhao Teng; Kristen Billiar; Dalin Tang Journal: IEEE Trans Biomed Eng Date: 2009-06-26 Impact factor: 4.538
Authors: Haofei Liu; Mingchao Cai; Chun Yang; Jie Zheng; Richard Bach; Mehmet H Kural; Kristen L Billiar; David Muccigrosso; Dongsi Lu; Dalin Tang Journal: Mol Cell Biomech Date: 2012-03
Authors: Joseph R Leach; Vitaliy L Rayz; Bruno Soares; Max Wintermark; Mohammad R K Mofrad; David Saloner Journal: Ann Biomed Eng Date: 2010-03-16 Impact factor: 3.934
Authors: Xueying Huang; Chun Yang; Jie Zheng; Richard Bach; David Muccigrosso; Pamela K Woodard; Dalin Tang Journal: J Biomech Date: 2016-06-08 Impact factor: 2.712
Authors: Dalin Tang; Zhongzhao Teng; Gador Canton; Thomas S Hatsukami; Li Dong; Xueying Huang; Chun Yuan Journal: Biomed Eng Online Date: 2009-08-03 Impact factor: 2.819