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High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction Evolving insights into the role of local shear stress in late stent failure from neoatherosclerosis formation and plaque destabilization Role of local coronary blood flow patterns and shear stress on the development of microvascular and epicardial endothelial dysfunction and coronary plaque Implications of the local hemodynamic forces on the formation and destabilization of neoatherosclerotic lesions Role of endothelial dysfunction in determining angina after percutaneous coronary intervention: Learning from pathophysiology to optimize treatment TAVI Represents an Anti-Inflammatory Therapy via Reduction of Shear Stress Induced, Piezo-1-Mediated Monocyte Activation Transcatheter Aortic Valve Implantation Represents an Anti-Inflammatory Therapy Via Reduction of Shear Stress-Induced, Piezo-1-Mediated Monocyte Activation Endothelial ACKR3 drives atherosclerosis by promoting immune cell adhesion to vascular endothelium
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Review Article2017 Nov;32(6):748-754.

JOURNAL:Curr Opin Cardiol. Article Link

Evolving understanding of the heterogeneous natural history of individual coronary artery plaques and the role of local endothelial shear stress

Antoniadis AP, Stone PH. Keywords: coronary artery plaques; local endothelial shear stress

ABSTRACT


PURPOSE OF REVIEWAnatomic and morphologic features of high-risk coronary plaque have been identified by novel imaging modalities, but it has been less clear which ostensibly high-risk plaques will actually destabilize and cause a new cardiac event. Different plaques with different morphologies coexist within the same artery, but the impact of this heterogeneity on the natural history of coronary artery disease has not been extensively investigated.


RECENT FINDINGS - Coronary plaques exhibit remarkable heterogeneity of local morphological and blood-flow patterns, including endothelial shear stress (ESS), along their longitudinal axis, with important implications for the heterogeneous natural history of coronary disease. The natural history of individual plaques is considerably divergent, with most plaques, even ostensibly high-risk plaques, becoming quiescent and only a minority progressing to destabilize and precipitate a new clinical event. Local areas of proinflammatory low ESS appear to be an important condition for plaque destabilization.

SUMMARY - Characterization of an individual atherosclerotic plaque based on a snapshot of morphological features at a specific location, such as the minimal lumen diameter, may not be sufficiently comprehensive to accurately reflect the risk associated with that plaque. A detailed assessment of both anatomical and functional pathobiologic characteristics in the longitudinal plaque dimension may enhance our understanding of atherosclerosis progression and improve the management of individual patients with coronary artery disease.