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Stress Analysis of Carotid Atheroma in Transient Ischemic Attack Patients: Evidence for Extreme Stress-Induced Plaque Rupture

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Abstract

Plaque rupture has been considered to be the result of its structural failure. The aim of this study is to suggest a possible link between higher stresses and rupture sites observed from in vivo magnetic resonance imaging (MRI) of transient ischemic attack (TIA) patients, by using stress analysis methods. Three patients, who had recently suffered a TIA, underwent in vivo multi-spectral MR imaging. Based on plaque geometries reconstructed from the post-rupture status, six pre-rupture plaque models were generated for each patient dataset with different reconstructions of rupture sites to bridge the gap of fibrous cap from original MRI images. Stress analysis by fluid structure interaction simulation was performed on the models, followed by analysis of local stress concentration distribution and plaque rupture sites. Furthermore, the sensitivity of stress analysis to the pre-rupture plaque geometry reconstruction was examined. Local stress concentrations were found to be located at the plaque rupture sites for the three subjects studied. In the total of 18 models created, the locations of the stress concentration regions were similar in 17 models in which rupture sites were always associated with high stresses. The local stress concentration region moved from circumferential center to the shoulder region (slightly away from the rupture site) for a case with a thick fibrous cap. Plaque wall stress level in the rupture locations was found to be much higher than the value in non-rupture locations. The good correlation between local stress concentrations and plaque rupture sites, and generally higher plaque wall stress level in rupture locations in the subjects studied could provide indirect evidence for the extreme stress-induced plaque rupture hypothesis. Local stress concentration in the plaque region could be one of the factors contributing to plaque rupture.

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Acknowledgments

This project was supported by the British Heart Foundation (FS/06/048). Dr Umar Sadat is supported by a Medical Research Council (UK) and Royal College of Surgeons of England Joint Clinical Research Training Fellowship.

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Authors and Affiliations

  1. Brunel Institute for Bioengineering, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK

    Hao Gao, Quan Long & Saroj Kumar Das

  2. Center for Excellence in Signal and Image Processing, Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow, G1 1XW, UK

    Hao Gao

  3. Consultant Surgeon, The Hillingdon Hospital & Charing Cross Hospital, Pield Heath Road, Uxbridge, UB8 3NN, UK

    Saroj Kumar Das

  4. University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK

    Umar Sadat, Martin Graves, Jonathan H. Gillard & Zhi-Yong Li

  5. School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, China

    Zhi-Yong Li

Authors
  1. Hao Gao
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  2. Quan Long
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  3. Saroj Kumar Das
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  4. Umar Sadat
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  5. Martin Graves
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  6. Jonathan H. Gillard
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  7. Zhi-Yong Li
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Correspondence to Quan Long.

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Associate Editor Peter E. McHugh oversaw the review of this article.

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Gao, H., Long, Q., Das, S.K. et al. Stress Analysis of Carotid Atheroma in Transient Ischemic Attack Patients: Evidence for Extreme Stress-Induced Plaque Rupture. Ann Biomed Eng 39, 2203–2212 (2011). https://doi.org/10.1007/s10439-011-0314-5

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  • DOI: https://doi.org/10.1007/s10439-011-0314-5

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