Necrotic core thickness and positive arterial remodeling index: emergent biomechanical factors for evaluating the risk of plaque rupture
Necrotic core thickness and positive arterial remodeling index: emergent biomechanical factors for evaluating the risk of plaque rupture
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DOI：
10.1152/ajpheart.00005.2008
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发表时间：
2008-08-01
影响因子：
4.8
通讯作者：
Pettigrew, Roderic I.
中科院分区：
文献类型：
--
作者：
Ohayon, Jacques;Finet, Gerard;Pettigrew, Roderic I.
纤维帽厚度通常被认为是斑块不稳定程度的诊断指标。另一方面，坏死核心面积（Corearea）和动脉重塑指数（Remodindex）难以用作临床形态学指标：文献数据显示Corearea阈值分布广泛，高于该阈值斑块变得不稳定。尽管组织病理学显示Corearea和Remodindex之间存在很强的相关性，但仍不清楚它们如何相互作用并影响峰值帽应力（Capstress），这是一种已知的破裂预测因子。本研究的目的是调查斑块易损性的变化作为坏死核心大小和斑块形态的函数。在5，500个理想化动脉粥样硬化血管模型上计算Capstress值，这些模型具有模拟Glagov描述的正动脉重塑过程的原始特征。24个通过血管内超声获得的患者非破裂斑块被用来测试相关理想化形态模型的性能。利用广泛的模拟，我们研究了解剖斑块特征对Capstress的影响。结果发现：1）在正性重塑的早期阶段，病变更容易破裂，这可以解释临床无症状斑块的进展和生长; 2）除了冠状厚度外，坏死核心厚度而不是面积在确定斑块稳定性方面至关重要。这项研究表明，斑块不稳定性被视为不是单独的纤维帽厚度的结果，而是作为帽厚度，坏死核心厚度和动脉重塑指数的组合。
Fibrous cap thickness is often considered as diagnostic of the degree of plaque instability. Necrotic core area (Corearea) and the arterial remodeling index (Remodindex), on the other hand, are difficult to use as clinical morphological indexes: literature data show a wide dispersion of Corearea thresholds above which plaque becomes unstable. Although histopathology shows a strong correlation between Corearea and Remodindex, it remains unclear how these interact and affect peak cap stress (Capstress), a known predictor of rupture. The aim of this study was to investigate the change in plaque vulnerability as a function of necrotic core size and plaque morphology. Capstress value was calculated on 5,500 idealized atherosclerotic vessel models that had the original feature of mimicking the positive arterial remodeling process described by Glagov. Twenty-four nonruptured plaques acquired by intravascular ultrasound on patients were used to test the performance of the associated idealized morphological models. Taking advantage of the extensive simulations, we investigated the effects of anatomical plaque features on Capstress. It was found that: 1) at the early stages of positive remodeling, lesions were more prone to rupture, which could explain the progression and growth of clinically silent plaques and 2) in addition to cap thickness, necrotic core thickness, rather than area, was critical in determining plaque stability. This study demonstrates that plaque instability is to be viewed not as a consequence of fibrous cap thickness alone but rather as a combination of cap thickness, necrotic core thickness, and the arterial remodeling index.