Plaque Progression in a Human Coronary Artery is Associated With Low Wall Shear Stress and Extended Particle Residence Time

Intravascular ultrasound (IVUS) evaluation was performed in the coronary arteries of a 45-year-old patient with stable angina during vigorous physical activity. Concurrent angiography demonstrated a mild plaque in the proximal left anterior descending artery (LAD), with obvious lumen dilatation immediately distal to the plaque. Blood velocity was measured by a catheter Doppler transducer at proximal and distal segments of the left coronary artery, and the left main artery (LM) and LAD were reconstructed using a 3D-IVUS reconstruction technique based on biplanar angiography and IVUS images, enabling simulation of the flow field in the artery employing computational fluid dynamics (CFD). Wall shear stress (WSS) and particle path lines were determined from the CFD studies. The patient returned for a follow up evaluation after 6 months, and plaque progression during this period was evaluated from the IVUS data. Results showed that low WSS, less than 5 dynes/cm², which occurs in the region immediately distal to the plaque, correlates with localized progression of the lesion over the 6 month interval. The path line tracking computations showed that particles near the vessel surface where plaque progression was observed resided near the artery wall longer than one complete cardiac cycle, whereas in other areas particles were flushed through the region of interest rapidly. These observations in a specific individual are consistent with the hypothesis that plaque progression is related to low WSS and relatively long residence time of atherogenic blood-borne substances.