Study of carotid arterial plaque stress for symptomatic and asymptomatic patients
Study of carotid arterial plaque stress for symptomatic and asymptomatic patients
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DOI：
10.1016/j.jbiomech.2011.07.012
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发表时间：
2011-09-23
影响因子：
2.4
通讯作者：
Li, Zhi-Yong
中科院分区：
文献类型：
--
作者：
Gao, Hao;Long, Quan;Li, Zhi-Yong
中风是世界上主要的死亡原因之一，主要由动脉粥样硬化斑块的突然破裂引起。迄今为止，斑块破裂的确切机制尚未完全清楚，斑块破裂的危险分层也未完全清楚。先进的多光谱磁共振成像（MRI）允许斑块成分在体内可视化，并通过计算建模进行重建。在这项研究中，使用完全耦合的流体结构相互作用的斑块应力分析应用于20例患者（12例有症状和8例无症状）从体内MRI重建，然后进行详细的生物力学分析，和形态学特征研究。根据本研究病例，在纤维帽区域可以发现局部极端应力条件，85%在斑块肩部。有症状患者的斑块区域预测局部最大应力值显著高于无症状患者（200 +/- 43 kPa vs. 127 +/- 37 kPa，p=0.001）。斑块应力水平（根据纤维帽中计算节点上经历的应力的累积直方图，排除纤维帽区域中5%的最高应力节点定义）在有症状的患者中也显著高于无症状患者（154 +/- 32 kPa vs. 111 +/- 23 kPa，p < 0.05）。尽管两组患者的脂质核心大小无显著差异，但基于使用2D轮廓堆叠的3D插值重建的斑块，有症状组通常具有较大的脂质核心和显著较薄的纤维帽。具有较高狭窄的斑块更可能在斑块喉部上游具有极端应力条件。斑块MR图像和斑块应力的联合分析将有助于我们对斑块破裂的认识，并为斑块破裂风险的评估提供有用的工具。(C)2011爱思唯尔有限公司保留所有权利。
Stroke is one of the leading causes of death in the world, resulting mostly from the sudden ruptures of atherosclerosis carotid plaques. Until now, the exact plaque rupture mechanism has not been fully understood, and also the plaque rupture risk stratification. The advanced multi-spectral magnetic resonance imaging (MRI) has allowed the plaque components to be visualized in-vivo and reconstructed by computational modeling. In the study, plaque stress analysis using fully coupled fluid structure interaction was applied to 20 patients (12 symptomatic and 8 asymptomatic) reconstructed from in-vivo MRI, followed by a detailed biomechanics analysis, and morphological feature study. The locally extreme stress conditions can be found in the fibrous cap region, 85% at the plaque shoulder based on the present study cases. Local maximum stress values predicted in the plaque region were found to be significantly higher in symptomatic patients than that in asymptomatic patients (200 +/- 43 kPa vs. 127 +/- 37 kPa, p=0.001). Plaque stress level, defined by excluding 5% highest stress nodes in the fibrous cap region based on the accumulative histogram of stress experienced on the computational nodes in the fibrous cap, was also significantly higher in symptomatic patients than that in asymptomatic patients (154 +/- 32 kPa vs. 111 +/- 23 kPa, p < 0.05). Although there was no significant difference in lipid core size between the two patient groups, symptomatic group normally had a larger lipid core and a significantly thinner fibrous cap based on the reconstructed plaques using 3D interpolation from stacks of 2D contours. Plaques with a higher stenosis were more likely to have extreme stress conditions upstream of plaque throat. The combined analyses of plaque MR image and plaque stress will advance our understanding of plaque rupture, and provide a useful tool on assessing plaque rupture risk. (C) 2011 Elsevier Ltd. All rights reserved.