Abstract
The relationship between high wall shear stress (WSS) and plaque rupture (PR) in longitudinal and circumferential locations remains uncertain. Overall, 100 acute coronary syndrome patients whose culprit lesions had PR, documented by optical coherence tomography (OCT), were enrolled. Lesion-specific three-dimensional coronary artery models were created using OCT data. WSS was computed with computational fluid dynamics analysis. PR was classified into upstream-PR, minimum lumen area-PR, and downstream-PR according to the PR’s longitudinal location, and into central-PR and lateral-PR according to the disrupted fibrous cap circumferential location. In the longitudinal 3-mm segmental analysis, multivariate analysis demonstrated that higher WSS in the upstream segment was independently associated with upstream-PR, and thinner fibrous cap was independently associated with downstream-PR. In the PR cross-sections, the PR region had a significantly higher average WSS than non-PR region. In the cross-sectional analysis, the in-lesion peak WSS was frequently observed in the lateral (66.7%) and central regions (70%) in lateral-PR and central-PR, respectively. Multivariate analysis demonstrated that the presence of in-lesion peak WSS at the lateral region, thinner broken fibrous cap, and larger lumen area were independently associated with lateral-PR, while the presence of in-lesion peak WSS at the central region and thicker broken fibrous cap were independently associated with central-PR. In conclusion, OCT-based WSS simulation revealed that high WSS might be related to the longitudinal and circumferential locations of PR.
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Hiromasa Otake, Junya Shite, Amane Kozuki, and Tomofumi Takaya received honoraria for lectures from Abbott Vascular. Fumiyasu Seike received honoraria for lectures and a grant from Abbott Vascular. Osamu Yamaguchi and Ken-ichi Hirata received grant support from Abbott Vascular. The other authors declare that they have no conflict of interest.
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Fukuyama, Y., Otake, H., Seike, F. et al. Potential relationship between high wall shear stress and plaque rupture causing acute coronary syndrome. Heart Vessels 38, 634–644 (2023). https://doi.org/10.1007/s00380-022-02224-7
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DOI: https://doi.org/10.1007/s00380-022-02224-7