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(Circulation. 2008;117:987-989.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Prediction of the Localization of High-Risk Coronary Atherosclerotic Plaques on the Basis of Low Endothelial Shear Stress: An Intravascular Ultrasound and Histopathology Natural History Study

 
The present study describes experiments in diabetic hyperlipidemic swine capable of developing humanlike high-risk plaques (ie, thin cap fibroatheromas). Local endothelial shear stress (ESS) was calculated in vivo with the use of vascular profiling techniques (intravascular ultrasound and coronary angiography) in plaque-free subsegments of interest at baseline (week 23), and these subsegments were analyzed histopathologically at follow-up (week 30), demonstrating that (1) arterial subsegments with the lowest values of ESS are those regions where high-risk plaques with large lipid core, intensive inflammation, and thin fibrous cap will develop; (2) the severity of high-risk plaque characteristics (ie, lipid accumulation and inflammatory cell infiltration) is correlated with the magnitude of low ESS; and (3) very low ESS induces an intense inflammatory response that leads to severe internal elastic lamina degradation and subsequent excessive expansive remodeling (ie, excessive lumen and wall expansion). These wall changes further reduce local ESS, establishing a cascade of inflammation and excessive expansive remodeling, which can transform an early atherosclerotic lesion into a high-risk plaque. These findings indicate that application of vascular profiling methods for the in vivo understanding of local ESS and vascular remodeling response, which are responsible for individual plaque behavior and natural history, may allow for detailed risk stratification and identification of a high-risk plaque in its early stages of development. Early in vivo identification of a high-risk plaque may provide a rationale for highly selective, prophylactic local coronary interventions (eg, implantation of stents), supplemented by an intensive systemic pharmacological approach, to avert a future acute . . . [Full Text of this Article]

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