Discordance of the Areas of Peak Wall Shear Stress and Tissue Stress in Coronary Artery Plaques as Revealed by Fluid-Structure Interaction Finite Element Analysis A Case Study

Simulation studies have been performed in attempts to elucidate the significance of shear and tissue stresses in the progression and rupture of coronary artery plaques, but few studies have analyzed both stresses simultaneously. We analyzed the distributions of shear stress and tissue stress in a model of coronary artery plaque based on intravascular ultrasound data by fluid-structure interaction finite element analysis under physiological pressure and flow. As shown in previous studies, the region of peak shear stress was observed at the proximal side of the plaque where flow velocity was high but its value was at most 10 Pa. On the other hand, 1000-10,000 times greater tissue stress was located in the stenotic region but the location of peak tissue stress was different from that of shear stress. We also found that stenting not only stabilizes the stented segment but also reduces the stress in the adjacent region. Fluid-structure interaction analysis revealed discordance in the distribution of shear and tissue stresses. These two stresses exert distinct influences on the coronary plaque, rupture of which may occur where tissue stress exceeds the plaque strength, which is weakened by pathological processes triggered by shear stress.