Establishing the Hemodynamic Determinants of Human Plaque Configuration, Composition and Complication
We now have sound information concerning the distribution of intimai thickenings and atherosclerotic plaques at clinically important sites in humans. Low and/or oscillatory wall shear stress are the associated hemodynamic conditions at these locations. It is also evident that artery walls may compensate for hemodynamic changes and for the development of atherosclerotic disease and maintain lumen diameters and configurations consistent with adequate flow. Obstruction occurs when the adaptive processes do not keep pace with plaque enlargement or when plaques are disrupted. Future investigations must therefore include studies of plaque growth and composition in relation to variations in geometric configuration, pulse rate and flow velocity. Until the disease can be prevented it is necessary to identify those features of plaque composition and configuration which underlie susceptibility to instability and to characterize the hemodynamic and other mechanical circumstances which may induce plaque disruption and those which favor the maintenance of an adequate and stable channel. Such studies place renewed emphasis on the fact that the artery wall and the atherosclerotic plaque are living tissues, capable of healing and adaptive restructuring as well as degeneration and disruption.
KeywordsWall Shear Stress Atherosclerotic Plaque Plaque Formation Artery Wall Intimal Thickening
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