Ultrasound Assessment of the Relation Between Local Hemodynamic Parameters and Plaque Morphology

Mechanical factors, especially wall shear stress (WSS) and circumferential strain (CS), play an important role in the progression and rupture of atherosclerotic plaques. Previous studies have shown that the temporal phase angle between WSS and CS, referred to as the stress phase angle (SPA) may be a biomarker for plaque development and vulnerability. Since the SPA is influenced by the severity and length of the stenosis, a multifactorial relationship between local hemodynamic variables and plaque morphology can be hypothesized. However, due to ethical restrictions and the difficulty of developing animal models, there is little experimental data to support such a hypothesis about the biomarker function of SPA. In this study, a novel non-invasive ultrasound-based method for investigating the relationship between local hemodynamics and plaque morphology is developed and investigated in-vitro and in-vivo with an apolipoprotein deficient mouse model. In the in-vitro experiments, using polyvinyl alcohol cryogel (PVA-c) phantoms, we have observed that the SPA becomes more negative and the wall shear rate (WSR) rises, as the severity of the stenosis increases. Conversely, SPA becomes more positive and WSR falls with increasing plaque length. These changes in plaque morphology have little effect on CS. The in-vivo experiments show that, as the severity of the plaque increases, the SPA becomes more negative and WSR tends to more positive values; whereas, the CS drops. We conclude that these local hemodynamic parameters such as SPA, WSR and CS, as suggested by others, can be regarded as prognostic markers for the assessment of plaque vulnerability.