Exploring the relationship between biomechanical stresses and coronary atherosclerosis


      • Biomechanical factors can promote growth and destabilisation of plaques.
      • Our ability to accurately predict vulnerable plaques remains underdeveloped.
      • Endothelial Shear Stress is the biological manifestation of wall shear stress.
      • Plaque Structural Stress is stress within the atherosclerotic plaque.
      • Axial Plaque Stress is the internal stress which resists changes in vessel length.


      The pathophysiology of coronary atherosclerosis is multifaceted. Plaque initiation and progression are governed by a complex interplay between genetic and environmental factors acting through processes such as lipid accumulation, altered haemodynamics and inflammation. There is increasing recognition that biomechanical stresses play an important role in atherogenesis, and integration of these metrics with clinical imaging has potential to significantly improve cardiovascular risk prediction. In this review, we present the calculation of coronary biomechanical stresses from first principles and computational methods, including endothelial shear stress (ESS), plaque structural stress (PSS) and axial plaque stress (APS). We discuss the current experimental and human data linking these stresses to the natural history of coronary artery disease and explore the future potential for refining treatment options and predicting future ischaemic events.

      Graphical abstract


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