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Assessment of shear stress to predict plaque destabilization

Assessment of shear stress based on bi-plane angiography for the prediction of plaque destabilization in coronary arteries

Investigators: Jelle Schrauwen, Jolanda Wentzel, Frank Gijsen, Wiro Niessen

Vulnerable plaques are advanced atherosclerotic plaques that are characterized by the presence of a lipid pool covered by a thin fibrous cap. Rupture of the fibrous cap will expose the content of the lipid pool to the blood, which leads to thrombus formation and subsequent occlusion of the coronary artery.

Wall shear stress (WSS) - the frictional force of the blood at the vessel wall - plays an important role in the development and progress of atheroslcerotic plaques. WSS can be calculated by performing computational fluid dynamics (CFD) calculations based on patient specific 3D reconstruction of the lumen of the coronary artery. The 3D reconstruction for CFD will be derived from bi-plane angiography.

Although WSS seems to be a relevant parameter in predicting plaque rupture, it is unlikely that elevated WSS alone is enough to identify rupture prone plaques. Cap thickness is a well known geometrical risk factor and a potential candidate to predict the location of plaque rupture. The thickness of the cap can be derived from optical coherence tomography (OCT).

The aim of the project is to develop tools to determine new diagnostic parameters to identify rupture prone plaques in a clinical setting by the fusion of WSS and cap thickness data. Therefore we will develop new image-based tools to improve both identification of rupture prone plaques and risk prediction.