On the axial distribution of plaque stress: Influence of stenosis severity, lipid core stiffness, lipid core length and fibrous cap stiffness

Abstract

Numerical simulations of blood flow through a partially-blocked axisymmetric artery are performed to investigate the stress distributions in the plaque. We show that the combined effect of stenosis severity and the stiffness of the lipid core can drastically change the axial stress distribution, strongly affecting the potential sites of plaque rupture. The core stiffness is also an important factor when assessing plaque vulnerability, where a mild stenosis with a lipid-filled core presents higher stress levels than a severe stenosis with a calcified plaque. A shorter lipid core gives rise to an increase in the stress levels. However, the fibrous cap stiffness does not influence the stress distributions for the range of values considered in this work. Based on these mechanical analyses, we identify potential sites of rupture in the axial direction for each case: the midpoints of the upstream and downstream regions of the stenosis (for severe, lipid-filled plaques), the ends of the lipid core (for short cores), and the middle of the stenosis (for mild stenoses with positive remodelling of the arterial wall).

Keywords: Atherosclerosis; Elastic wall; Fluid-structure interaction; Plaque rupture; Stenotic flow.