Emergent biomechanical factors predicting vulnerable coronary atherosclerotic plaque rupture

Abstract This chapter focuses on physiological intraparietal stress distribution in vulnerable atherosclerotic plaques (VPs) and its potential for identifying VPs at high risk of rupture. Although several clinical and biomechanical studies have identified plaque morphology as a key predictor of vulnerability to rupture, predicting rupture remains imprecise, as the thickness of the fibrous cap is not in itself enough to predict plaque instability. Our hypothesis was that the discrepancy between the precision of our knowledge of the morphological characteristics of a VP and their poor predictive value with respect to rupture is largely due to the complexity of the biomechanical interactions involved. It is essential to understand how the VP’s anatomical and mechanical characteristics interact during the growth process, increasing our fundamental knowledge of VP instability, while providing a more accurate evaluation of the risk of rupture. This chapter presents and discusses such biomechanical interactions.